Region Director Payer Strategy

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

#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.