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Region Director Payer Strategy

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Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

This is a remote position with a strong preference for someone to be located in California and have California managed care experience.

The Regional Director, Payer Strategy and Relationships (PSR), is a remote position and is responsible for managed care policies, goals and objectives related to contract language and reimbursement (capitation, fee-for-service, and quality incentive programs), negotiation strategy, and payer relationships for all Physician Enterprise and hospital-based clinic physician entities across California. There are currently 12 Medical Groups with 160+ clinic sites and over 5,000 physicians in our medical networks. It is preferred that the candidate resides in the California market and must have extensive experience working with California health plans and IPAs. The Regional Director is primarily focused on payer relationships and health plan contracting for all managed care lines of business and collects and communicates Region-level insight and strategic knowledge to/from the PSR National Payer teams, Physician Enterprise, the PSR Growth & Innovation team, and other key departments across the enterprise. This position is essential to CommonSpirit Health’s financial performance, and has significant impact on the long-term strategic trajectory of the organization. This position secures optimal fee for service and value-based reimbursement, protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations, and strengthens CommonSpirit Health’s relationships with payers.

Key Responsibilities

Participates in the development of regional strategy, relationships, and contracts with local and national payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation. Budgeted and forecasted performance and growth requirements as set forth by national and regional senior leaders are integral to these processes.

Gathers information and guidance from Regional PSR VP, ministry leaders, internal stakeholders, and financial analysis relative to the strategic, operational, financial needs and expectations of the CA Region related to the National Payers; proactively communicates with the PSR National Payer teams.

Establishes, builds, and maintains positive, strategic interactions and relationships with payers, employers, providers, and leaders across the ministry. Maintains relationships with National Payer contacts with offices in the region.

In collaboration with Regional Leadership and other PS&R Leadership, develops and executes communication plans and Payer Negotiation Outlines related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace including Fee For Service and Value-Based Agreements in support of CommonSpirit Health’s Healthier Communities strategy.

Makes independent decisions and/or exercises judgment based upon appropriate information and objectives. Comprehends and maintains highly detailed information. Accepts and carries out responsibility for direction, control, and planning.

Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges, market competition, etc.

Supports the strategic objectives of CommonSpirit Health’s IDNs, population health, and care management initiatives through directly engaging local payers and employer customers, including CSH employee health benefits.

Participates in and contributes to CommonSpirit Health’s PSR knowledge base through sharing best practices, developing contract performance goals, key metrics, new analytical tools, network development, reimbursement and language guidelines, revenue realization, and other applicable work streams.

Represents Physician Enterprise entities in Provider Excess bidding process with broker each year to analyze and establish appropriate coverage for each market population. This is done along with other Directors representing hospital interests.

Participates in the dispute resolution and denials processes with local payers if the materiality exceeds $1M. Participates in joint operating committees and denial committees for Physician Enterprise as needed.

Leads and organizes sub-projects necessary to support local and national payer negotiations and growth.

#LI-CSH

Qualifications

Education and Experience:

Bachelor’s Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree
Minimum of five (5) years of recent experience in the managed care industry with responsibility for strategy and negotiations.
Minimum of four (4) years of leadership and supervisory experience

Required Minimum Knowledge, Skills, Abilities, Training

Working knowledge of provider and payer industry.
Strength in assessing problems and implementing solutions.
Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.
Proven and extensive technical skills, negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies for both fee for service and value-based contracts, including capitation and various incentive programs.
Demonstrated ability to set and maintain multiple priorities in an environment with shifting priorities, while providing accurate deliverables in a timely fashion.
Strength in self-motivation and ability to assume ownership of assignments and projects. Driven to succeed.
Strong interpersonal, verbal, and writing skills in dealing with payers, guests and team members.

Average salary estimate

$135000 / YEARLY (est.)

min

max

$120000K

$150000K

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What You Should Know About Region Director Payer Strategy, UNAVAILABLE

If you're looking for an exciting role where you can truly make a difference, consider the position of Regional Director of Payer Strategy at CommonSpirit Health, located in the beautiful Rancho Cordova, California. In this remote position, you'll be at the forefront of driving managed care policies and shaping the future of healthcare delivery across California. Your primary responsibilities will revolve around negotiating contracts and establishing strong partnerships with various health plans, ensuring optimal reimbursement models that align with our mission of providing compassionate care. You'll engage directly with over 5,000 physicians across our expansive network, fostering relationships and implementing strategic initiatives that not only fulfill our organizational goals but also enhance community health outcomes. To thrive in this role, you should come equipped with a wealth of experience in the California managed care market, backed by a solid history of leadership and negotiation prowess. We're looking for innovative thinkers who can navigate this complex landscape, drawing insights from diverse stakeholders and effectively communicating this information across teams to align our payer strategy with overall financial performance. By joining CommonSpirit Health, you will be part of a dedicated team committed to transformation in healthcare, supporting our vision of healthier communities while working within a dynamic, employer-based model. This role calls for a motivated individual ready to dive into the evolving world of payer relationships and health plan contracting. If you have the experience and are eager to contribute to a cause that matters, we’d love to connect with you and see how you can be a part of our vision.

Frequently Asked Questions (FAQs) for Region Director Payer Strategy Role at UNAVAILABLE

What are the main responsibilities of the Regional Director Payer Strategy at CommonSpirit Health?

The Regional Director Payer Strategy at CommonSpirit Health is responsible for developing managed care policies, negotiating contracts, and maintaining strong relationships with health plans across California. This role involves strategic planning, gathering insights from various stakeholders, and ensuring the financial health of our Physician Enterprise and hospital-based clinics.