The Care Delivery Organization, a wholly owned subsidiary of Humana Inc., which provides senior focused primary care through its clinics and MSO services in multiple markets across the U.S., is searching for a Market VP of Payer Contracting and Sales
The job will have oversight of:
- Payer contracting strategy: Align contracting strategy to overall growth strategy; design contracts to maximize PIPC growth and value capture; negotiate and execute strategies; develop and manage payer relationships; build and manage internal processes and infrastructure, including team; represent CDO nationally to payers
- Sales strategy and implementation: Design and implement national sales model; engage with local teams in partnership with local leadership; develop appropriate reporting and analytics; create community of practice and share best practices; partner with Patient Experience team re: patient attraction and retention
Responsibilities include but not limited to
- Develop and manage relationships with executives at multiple health plans, locally and nationally, in markets and corporate
- Successfully negotiate contracts value based contracts with various health plans using a diverse range of techniques and contracting ''best practices'', to include fee for service, capitation, quality reward programs, and path-to-risk arrangements.
- Management of Payer Contracting and Sales Strategy team, successfully support the goals of the organization.
- Execute and manage multiple expansion related priorities for the Care Delivery Organization.
- Develop, manage and implement nation-wide contracting and sales strategies.
- Manage contractual relationships and ensure accurate administration of contract terms including informing the various contracted health plans about newly credentialed providers.
- Provide ongoing intervention and assistance in the management of claims, UM and benefit issues.
- Collaborate with analytics team to identify cost savings initiatives and monitor contract performance.
- Develop appropriate reporting and analytics; create community of practice and share best practices; partner with Patient Experience team re: patient attraction and retention
- Ensure contract compliance with all requirements as set forth by State and Federal agencies.
- Supervise and execute special projects as assigned.
- Work with CDO market-based leaders on contracting and sales strategy, execution with local downstream affiliate providers and capitated specialist.
- Represent the CDO externally to key payer audiences
Our Ideal Candidate
This role is uniquely positioned to influence health care leaders and other stakeholders to think differently about health and wellness. Enthusiasm and passion for improving the health care system and overall provider experience is required, as is a track record of building outstanding working relationships, implementing strategic objectives and achieving quality and financial performance objectives to grow a business. Key personal attributes include: ability to build consensus and inspire others to achieve outstanding results, willingness to set priorities and maintain strategic focus, maintain the highest standards of integrity and business ethics and desire for personal and team success.
- BS/BA in business administration, finance or health care
- Minimum of 7 years of experience in health care administration
- 5-7 years combined experience in physician or health plan contracting and sales experience
- Ability to budget and obtain necessary medical cost targets
- Strong understanding of financial reports and the ability to manage accordingly
- Understand contract language and legal requirements for contracting
- Strong understanding of State and Federal Laws related to provider contracts
- Strong understanding of Medicare contracting and reimbursement methodology
- Broad based knowledge of health care, physician contracting and the various medical delivery systems
- Understanding of various financial reimbursement methodologies used in managed care contracts; CMS DRGs, Revenue Codes, APCs, RBRVS and ASC Groupers
- Negotiation, analytical skills and human interaction skills
- Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity
- Strong written and excellent communication skills
- Strong presentation skills
- Ability to interact with senior leadership team and provide recommendations on contract strategies and cost
- Expert knowledge of Excel, Access, PowerPoint and Contract Management System
- Strong Project Management skills
- Master’s Degree, MBA or MHA
- Health care finance
- Experience with value based contracts
Scheduled Weekly Hours