Director, Univera Contracting, Analytics & Value Based Care (Finance)

Job Description:

This position is responsible to negotiate, plan, direct and control the activities related to Professional, Facility and Value Based Care provider contracts and relationships, while also overseeing Provider Analytics. Responsible for driving vision and executing the strategy for assigned contracts. The position works to integrate and align payer strategy with corporate strategic objectives including population health contracting, contract management, operations processes and government reimbursement trends. Oversees contracting efforts related to new products, initiatives and regulatory updates.

Essential Accountabilities:

• Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards and other key process controls while maintaining and enhancing a strong relationship with providers. Has authority to act and speak on behalf of the company within broad parameters.
• Recommends alternative approaches and schedules to senior management as a solution to difficult contract negotiations; in cases where the recommendation exceeds budget constraints, a team of Regional Presidents, VPs and Senior VPs of the area will make final decision.
• Develop Value Based Care arrangements that increase opportunities for revenue growth and aligned incentives for appropriate management of total cost of a population.
• Assist setting the budget and plan for contracts for individual hospitals and providers based on critical knowledge and information about the individual or group that is being negotiated.
• Ensures timely renewals of agreements and fee schedules and ensures all agreements are implemented to optimize effectiveness.
• Develops and implements reimbursement and negotiation strategies for assigned provider types including endangered specialties and facility providers.
• Analyzes needs for various networks and negotiates with non par providers essential to the adequacy requirements for these multiple networks.
• Works collaboratively with medical and the quality improvement departments to ensure a solid understanding of initiatives; fully accountable to secure applicable language and agreement through negotiations to ensure medical and quality improvement needs are secured.
• Works with other internal areas in developing best practice principles around contract negotiations and reimbursement.
• Accountable for the impact of provider contracts on pricing points for all products and will act as a liaison with Utilization Management, Care Management and Actuarial/Finance to ensure appropriate strategies are developed and implemented relative to benefit expense management.
• Provides clear feedback to Provider Relations and Communications to ensure plans are effective in addressing provider issues and needs.
• Presents an effective and positive image of the Health Plan and its leadership by promoting Health Plans community initiatives and not for profit goals.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Bachelors degree in health care administration or relevant field required.
• In lieu of a degree, four - six (4-6) years of experience in progressive provider reimbursement analysis and contracting is required.
• Strong & demonstrated experience in finance, actuarial and/or negotiations.
• Five (5) years' experience in health care involved in contract negotiations with hospitals and providers with a minimum of four years leadership/management experience.
• Excellent communication and negotiation skills.
• Must be able to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders, and other providers of health and health related services and equipment.
• Must have a current and thorough understanding of health care, financial models, physician organizations, contracts, and the Corporations' products and must be able to effectively discuss these issues with others.
• Strong working knowledge of applicable reimbursement methodologies that they can articulate to providers.
• Current and working knowledge of government reimbursement and utilizes that knowledge in negotiations with providers.
• Knowledgeable of Blue Cross Association's and Health Plan's strategies and initiatives and able to articulate those appropriate to providers.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

D2: $110,714 - $199,286

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.