Providence Health & Services Regional Vice President - Payer Contracting (WA/MT) in Renton, Washington
Providence is calling for a Regional VP to lead payer contracting across Washington and Montana.
The Regional Vice President, Payer Contracting is the managed care leader at the regional level for Providence St. Joseph Health (PSJH) responsible for a payer portfolio of managed services across Commercial, Exchange, Medicare Advantage and Medicaid product lines. The Regional Vice President, Payer Contracting works collaboratively in partnership with system and regional leadership to develop and execute PSJH contacting strategies. The Regional Vice President, Payer Contracting serves as the Chief Contracting Officer for the Region working directly with the Chief Executives, Chief Financial Officers and Chief Strategy or Population Health Officers for the region. This position reports directly to the SVP of Contracting with a matrix relationship to the designated leaders in the region. The Regional Vice President, Payer Contracting serves on a team that works together to design and implement strategies for growing the managed care portfolio through price and volume. Manages key payer negotiations and develops partnership strategies with the goal of growing the payer portfolio and advancing payment models to expand value based reimbursement models. The Regional Vice President, Payer Contracting has a team of Directors, Senior Contract Managers and Contract Managers responsible for managing the contracts for all revenue associated with national and regional payers, including but not limited to payers such as United, Aetna, Cigna, Regence, Premera, Healthnet, Kaiser, Molina, Amerigroup, etc. This includes managing product development, contract execution, and revenue generated for Commercial, Medicare Advantage, Medicaid, and Accountable Care or Value Based Initiatives. This position is responsible for negotiating with national, regional, and local payers for commercial, government, and growth opportunities and also is responsible for negotiating the various fee structures within each payer contract, including but not limited to, traditional fee-for-service arrangements, capitated arrangements, attributed risk arrangements, quality bonuses and shared or full risk terms for accountable lives.
The position is responsible for developing and maintaining strong relationships between the payers and the providers within our system and those providers affiliated with PSJH. The position will work closely with our various ACO structures, physician groups, regional healthcare systems, and management structures to achieve the financial goals and strategic priorities identified by the system on an annual basis. The position will work closely with senior leadership at the System and regional levels, and with senior leaders in the Contracting Department, Population Health Division, and Operational Units of the Regional Delivery System and local ministries, including Clinical Programs, Finance, Revenue Cycle and Reimbursement to translate contract terms into clear actions that will allow us to perform from a financial, clinical, and operational standpoint. The Executive Director of Contracts must be able to balance the needs of the region, the system, and providers across the continuum without losing sight of our mission and core values as an organization.
Provide internal and external strategic direction for PSJH while developing aligned relationships between the system and the regional leadership.
In partnership with the regional leadership, develop the long term payer (i.e. managed care) strategy for the Region and leads the implementation of that plan.
Represent PSJH to the payer community and regional leadership in proposing and promoting new financial arrangements that advance the strategic vision of managing a population of lives.
Direct all third party contract renewals and manages negotiation activities in alignment with the Region and/or System objectives.
Lead the negotiation team and facilitates the implementation of national and regional contracts in the region.
Develop and maintain strong relationships and partnerships with key payers to advance PSJH’s goal of managing the health of our population.
Develop aligned relationships with Regional leadership by facilitating and maintaining strong working relationships between the Senior Contract Managers, Contract Managers, and other contracting staff and the regional leaders they serve.
Work with key Regional leadership to define contracting principles and contracting strategies that further the mission, vision and values of PSJH.
Develop pricing methodologies in support of new program or clinical business planning (i.e.: bundles, centers of excellence, etc.)
Be responsible for developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability and value.
Be capable of developing innovative risk sharing arrangements that increase opportunities for revenue growth and aligned incentives for appropriate management of the total cost of a population
Develop and negotiate rate structures within PPO, HMO and FFS products, as well as capitation, ACO, and other value based arrangements and in a manner that rewards PSJH for the spillover effect of managing the lives of a population.
Work with our system leaders in Clinical Program and Services to expand access to our traditional service areas, our Centers of Excellence, and community support services through the development of contracts or grants.
Work with payers to develop contracts that expand beyond our traditional service areas for Centers of Excellence and bundles.
In partnership with the Executive Director of Analytics and Payer Performance, direct the evaluation of payment models and ensures contract modeling done by managed care plans or payers is verified by PSJH contract analytics team throughout the negotiations.
Work with the Contract Analytics and Administration team to present financial options to the Contract Strategy Councils.
Ensure timely renewals of agreements and that all agreements are implemented effectively to optimize effectiveness.
Act promptly on management questions and requests from key stakeholders.
Educate regional leaders on emerging payment models and collaborates with appropriate system leadership on the development of new payment models.
Report on payer performance and emerging models of care to senior management along with recommended course of action.
Manage a team of senior contract managers, contract managers and specialists who are responsible for supporting the contracting work for the region.
Direct the preparation and maintenance of department reports. Prepare periodic reports for top management, as required.
Serve as the primary contact for the payers in the region and the assigned payers at the national level to ensure we are able to meet the needs of our strategic partners and provide the highest level of service.
Work with leadership to understand key initiatives and to ensure contracts are aligned with PSJH’s strategic goals.
Responsibly recommend and participate in the development of new services and programs and serve as a thought leader with the Provider contracting team on issues related to network development and value creation for the region.
Participate at a senior level on committees, work groups or with associations aimed at advancing the work of Payer Contracting.
Represent PSJH as a leader in health care industry association(s) and organization(s).
Participate in administrative staff meetings and attends other meetings as assigned.
Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
Assign staff responsibilities and ensures timely performance evaluations.
Work with the Government Programs and Population Health Informatics team on the implications of payment reform and health care reform at the federal, state, and local level.
Required education/experience for this position include:
Bachelor's Degree, preferably in healthcare administration, finance, business, or related field
Minimum 10 to 15 years' experience in contracting at a health system or health plan
Minimum of 10 years In leadership position-management of field based teams
Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives, preferably for an integrated health care delivery system or managed care company
Minimum of 10 years with increased contracting responsibility for a portfolio that covers >$5b in managed services
Contracting experience across a portfolio of products that include government programs e.g. Medicare Advantage, Medicaid and other Government programs preferred
Experience negotiating facility, professional, and continuum contracts for commercial, Medicare Advantage in a fee-for-service and alternative payment models to includnig Capitated
A thorough understanding of the financial arrangements of the hospital, health plan, and medical group in a capitated and non-capitated environments is required
Deep understanding of both fee-for-service and at-risk payer contracts. Current knowledge of the changing health care landscape at the national and state level
Strong working knowledge of health care contract language and negotiation strategies. Thorough knowledge of laws and regulations relating to managed care and other payer functions
Ability to develop strong, trusting external relationships with payers. Ability to gain confidence and trust of leadership across the organization
Creative, innovative thinker bringing new ideas and solutions to internal strategy discussions and contract negotiations. Ability to work collaboratively and credibly across senior leadership both at the system and regional levels
Capacity to analyze changes in policy and regulation and the impact on contracting strategy, current and future arrangements, and strategic goals
Ability to articulate complex concepts in a clear, concise manner across system and regional leadership levels
Ability to represent the Region effectively to regional, service area and system leadership, outside consultants, regulatory agencies and others
Willingness to perform both independently on micro functions as well as cooperatively on macro projects
Ability to manage change, promote positive interpersonal relationships
Excellent negotiation skills. Ability to create win-win outcomes in a contract negotiation
Excellent oral and written communication skills
Excellent financial and analytical skills with the ability to apply them effectively
Excellent organizational skills
Understanding of how to work effectively within a complex, matrix organization to approach the right people at the right time.
Ability to manage multiple initiatives simultaneously
Ability to close contract negotiations with successful results within tight timelines.
Preferred education/experience for this position include:
- Master's Degree in Business Administration (MBA), Health Administration (MHA); or equivalent educ/experience.
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Job Category: Leadership
Req ID: 319312