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Director - Payor Contracting

3 months ago

Irvine, United States Providence Health & Service Full time
Job Description

THE ROLE

The Regional Contracting Director is the managed care leader for Providence Health & Services. The leader is responsible to develop and lead the implementation of the Regional contacting strategy and assist in the development and implementation of the System strategy. The leader must be able to identify current and future market trends and incorporate them into the strategy. In addition this individual is responsible to help assign appropriate individuals to staff contract negotiation teams on behalf of Acute, Physician Group, and applicable ancillary services to ensure performance goals are attained to meet organizational needs. This individual will be responsible for balancing the individual ministry, Region, and System needs for purposes of maximizing our results in total. The leader will be responsible for helping to lead our Acute, physician group, and ancillary entity relations with respect to managed care, and in the development, implementation and monitoring of managed care systems and contracts.

This individual's responsibilities also include special projects as directed by the Regional Vice President, the applicable CFO of the Region and other top management.

The incumbent performs all duties in a manner that promotes Providence mission, values, and philosophy. In all aspects, the individual serves as a role model for the values and mission of the organization.

ESSENTIAL FUNCTIONS
  • Assists in Developing the longer term managed care strategy for the Region and leads the implementation of that plan.
  • Develops, implements, and maintains a managed care program in keeping with the System's mission, strategy, goals and objectives in coordination with PH&S philosophy, operational and financial resources.
  • Directs all third party contract renewals and negotiation activities in alignment with the Region and/or System objectives.
  • Works with key Region leadership to define Contracting Principles and contracting strategies that further the mission, vision and values of PH&S.
  • Ensures timely renewals of agreements.
  • Works with leadership to understand key initiatives and to ensure contracts are implemented effectively to optimize effectiveness.
  • Act promptly on management questions and requests.
  • Assigns staff responsibilities and ensure timely performance evaluations.
  • Directs the preparation and maintenance of department reports. Prepares periodic reports for top management, as required.
  • Leads management education as it relates to issues involving Payers, Programs/Products, and overall contracting in areas of accountability.
  • Responsibly recommends and participates in the development of new services and programs.
  • Participates and demonstrates leadership in health care industry association(s) and organization(s).
  • Participates in administrative staff meetings and attends other meetings as assigned.
  • Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
QUALIFICATIONS
  • Bachelor's Degree in Healthcare Administration, Finance, Business; or related field
  • Master's Degree in Business Administration (MBA), Health Administration (MHA); or equivalent educ/experience
  • 10 or more years of Healthcare experience
  • 8 years of experience in a Leadership/Management position
  • Extensive experience leading high profile contract negotiations, business planning, and strategic execution of initiatives
  • Previous experience in healthcare financial management leadership working within a large integrated healthcare system (preferred)
  • Excellent presentation and writing skills
  • Excellent listening and negotiation skills
  • Demonstrated analytical skills
  • Demonstrated planning and project management skills
  • Strategic thinker
  • Ability to build consensus and motivate people in an environment of constant change
  • Ability to establish strong working relationships at all levels of the organization.
  • A thorough understanding of the financial arrangements of the hospital, health plan, and medical group in a capitation and non-capitation relationship is required
  • Strong working knowledge of contract language and negotiation strategies
  • Knowledge of financial principles and practices and the ability to apply them effectively
  • Ability to solve practical problems and deal with a variety of variables in solutions where only limited standardization or guidance may exist
  • Ability to represent the Region effectively to regional, service area and system leadership, outside consultants, regulatory agencies and others
  • Willingness to perform both independently on micro functions as well as cooperatively on macro projects
  • Understand how to work effectively within a complex, matrixed organization to approach the right people at the right time
  • Ability to manage multiple initiatives simultaneously.


About Us

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.