Northern Light Health
Department: Managed Care Contracting
Position is located: Cianchette Professional Blding
Work Type: Full Time
Hours Per Week: 40 hours weekly
Work Schedule: 7:30 AM to 5:00 PM
Summary:
The Director of Payer Strategy & Managed Care operations (PSMCO) oversees all aspects of payer contracting and relations with responsibility for the strategy, negotiation and execution of fee-for-service and value-based contracts for Northern Light Health and its subsidiary member organizations. The director is responsible for managing the contractual relationships between Northern Light Health’s business partners (e.g. employers) and payers to assure strategic alignment across the Northern Light Health Enterprise. The director reports to the vice president (PSMCO) and partners with Northern Light Health's vice president & senior counsel on legal, strategic and relevant operational matters. The director collaborates with other vital departments such as strategy, finance, revenue cycle, decision support and Beacon Health. The director leads a team of contract managers and consultants that are responsible for negotiating and managing contracts with business partners and payers. The director is accountable for the overall financial and operational performance of Northern Light Health's contracts with commercial payers such as Aetna, Anthem, Cigna and United Healthcare and other third-party contracts impacting gross to net patient service revenue amounts for member organizations including Beacon Health. Contract performance with commercial payers relates to the financial yield that the contracts produce and to the administrative burden required to support these contracts. The director is similarly responsible for aligning both the tactical (near-term) and the strategic (long-term) objectives of Northern Light Health in each contract. Informing and influencing Northern Light Health senior leaders regarding emerging trends, obstacles and opportunities relative to industry and governmental developments related to payer/provider reimbursement methods and schemes is central to this function. Working within and across Northern Light Health departments, the director builds robust contract management systems, unit revenue templates and contract performance reporting tools that support Northern Light Health revenue objectives. Supporting the professional development of the payer strategy & managed care operations team is another central function of the director. Creating a high-performance team of professional contract negotiators that work collaboratively to achieve Northern Light Health's revenue objectives as the healthcare industry migrates for fee-for-service to value-based reimbursement is essential to NLH’s financial viability. Establishing a robust and effective relationship with the Revenue Cycle, Finance & Analytics and Information Technology Teams is essential to the overall success for this position.
Responsibilities:
- Leads by example and manages a team of highly effective contract consultants and analysts responsible for supporting contracts with business partners and payers.
- Collaborates with Revenue Cycle, Finance & Analytics, Beacon Health, member organizations and other departments to achieve financial and operational success for the Northen Light Health Enterprise.
- Assists in the development of a payer strategy that supports the NLH near and long-term financial and operational goals.
- Assist Northern Light Health’s effective transition to reference-based pricing methodologies.
- Display data and models that illustrate how aligning with business partners and payers on access, cost, quality and patient satisfaction supports Northern Light Heath's objectives.
- Partner with the Vice President and Beacon Health to establish value-based contracts that delivers a sustainable and growing source of revenue to Northern Light Health.
- Assists in the creation of and implementation of payer strategies that create a competitive payer landscape that ensures Northern Light Health enjoys a diverse payer profile over the long-term.
- Fosters an environment that encourages professional development within the payer strategy & managed care operations team.
Other Information:
Competencies and Skills
- Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
- Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
- Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
- Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.
- Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
- Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
- Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
- Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .
Education
- Required Bachelor's Degree
Working Conditions
- Need to drive to perform responsible duties.
- Prolonged periods of sitting.