Registered Nurse – Care Manager
Advocate Aurora Health
Director of Payer Contracting, Ambulatory, Transplant and Ancillary Services
Cleveland Clinic
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
Visit company websiteJob Level
Lead
About the role
- Lead national payer contracting and network growth for ASCs, Transplant and Gene Therapy programs and Ancillary Services.
- Partner with cross functional teams including pricing, managed care, operations, analytics, finance, joint venture and physician partners and clinical leadership to align contracts with financial goals and care delivery models.
- Drive value-based payment initiatives, oversee payer relationships, ensure compliance and lead a high performing contracting team.
- Partner with internal stakeholders and joint venture partners to identify growth opportunities and expand the clinically integrated network.
- Lead the development of business plans and product strategies to support population health, risk capture, ASC, Transplant, Gene Therapy and Ancillary Service expansion.
- Seek new market opportunities in OH, FL, NV and elsewhere to expand payer and provider relationships through innovative contracting solutions.
- Ensure contract operationalization in partnership with revenue cycle, finance, joint venture teams and clinical institutes.
- Develop tools and workflows for efficient contract modeling, performance tracking and implementation.
- Manage the communication and approval process for new and renew contracts, including reporting to Sr. Director - Payer Contracting, Executive Leadership and Joint Venture Boards.
- Cultivate and maintain strong payer relationships to facilitate favorable negotiations and long-term partnership success.
- Communicate complex contractual elements and ensure alignment with internal revenue cycle and clinical operations.
- Identify and escalate payer issues with appropriate internal stakeholders.
- Lead the ASC, Transplant, Gene Therapy and Ancillary Contracting team, ensuring appropriate delegation of responsibilities, resource utilization and adherence to policies.
- Provide leadership coaching, mentoring, guidance and support for team development and performance.
- Monitor compliance with contract terms, government regulations and CCF organizational standards.
- A caregiver in this role works remotely from 8:00 a.m. – 5:00 p.m. Candidates for this position are preferred to reside in Ohio, Nevada, or Florida.
Requirements
- Bachelor’s degree in healthcare administration, Business, Finance or a related field and ten years of healthcare payer contracting, including ASC's, transplants, ancillary services, or multi-specialty practice settings
- Seven years of leadership or management role within a healthcare system or contracting department
- Deep understanding of healthcare payer markets, reimbursement models, provider network structures, joint venture and physician partner relationships
- Strong negotiation, relationship management and conflict resolution skills.
- Excellent analytical and financial modeling capabilities
- Proficient with Microsoft Office and contract management software Preferred qualifications:
- Master’s degree
- Ten years proven track record in healthcare strategic planning, managed care negotiations and business development
- Seven years of experience with contract modeling, value-based reimbursement and population health strategies.
- Two years of experience with joint venture and/or physician partners regarding managed care contracting
- Mentor/coaching experience
