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Regional Vice President - Payer Contracting (WA/MT)

Swedish Medical Center
Irvine, CA
  • Expired: October 14, 2021. Applications are no longer accepted.

Providence is calling for a Regional VP to lead payer contracting across our Washington and Montana regions.
 

THE ROLE

This regional market role is responsible for developing the strategies and managing the negotiations for all payer contracts across Providence St. Joseph Health System (PSJH).  The Vice President of Contracting and Payer Relations will supervise a team of Regional Directors 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, 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. The position is responsible for negotiating the various fee structures within each payer contract, including but not limited to, traditional fee-for-service arrangements, attributed life 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, PSJH and the providers affiliated with the system. 

 

The position will work closely with senior leadership both at the system level and within each region to ensure payer contracts are aligned with our system vision while also recognizing the unique needs of individual markets.  The position will work closely with the leaders within the Population Health Division, specifically Physician Services and Value Based Care to move forward the goal of increasing the number of accountable lives served by the system.  The position will work closely with senior leaders, including the Regional Chief Executive, Chief Financial Officer, Chief Medical or Clinical Officer, and Chief Strategy or Population Health Officer, and other senior leaders responsible for medical group or hospital operations to translate contract terms into clear actions that will allow us to perform in a financially successful manner for the managed care elements of these contracts.

 

The position will assist in developing the operational infrastructure necessary for PSJH to build a sustainable clinically and financially integrated delivery system by tracking and managing the evolving payment and incentive structures. It is essential that the Vice President have knowledge and experience with designing and evaluating payment models that will position PSJH for success in the short term and long term.  The position will work closely with the leadership to establish principles that will guide the system's efforts to establish strong relationships with payers and purchasers, strategic clinical partners, and the community PSJH serves.

 

The position is expected to perform all duties in a manner that reflects the PSJH mission and philosophy with a strong commitment to serving the poor and the vulnerable.

 

ESSENTIAL FUNCTIONS

 

The Regional Vice President, Contracting and Payer Relations will:

  • Provide internal and external strategic direction for PSJH at the system and regional level regarding payer contracting and network development.
  • Develop aligned relationships with Regional leadership by facilitating and maintaining strong working relationships between the Regional Directors and the regional leaders they serve.
  • Advise system management in the overall direction of payer relationships and programs
  • Be responsible for developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability and value
  • Lead the negotiation and implementation of national and large regional contracts across the system.
  • Be a thought leader regarding network management and value creation for the system
  • Research and prepare organization in collaboration with applicable functional leaders, for federal/state health reform, plus regulatory issues in relation to health benefits, payer products and reimbursement methodologies
  • Direct evaluation and contract modeling with managed care plans in support of payer negotiations.
  • Develop strong relationships and partnerships with key payers to advance PSJH goals of managing the health of our population.
  • Develop innovative risk sharing arrangements that increase opportunities for revenue growth and reward for appropriate management of total cost of a population
  • Develop and negotiate rate structures within PPO, HMO and FFS products in manner that rewards PSJH for the spillover effect of managing the lives of a population.
  • Work with payers to develop contracts that expand beyond our traditional service areas for Centers of Excellence and bundles.
  • 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.
  • Develop pricing methodologies in support of new programs or clinical business planning (i.e. bundles, centers of excellence, etc.)
  • Educate leadership on emerging models of care and collaborate with appropriate system leadership to ensure development of the clinical, financial and operational infrastructure necessary to be successful in these new models of care.
  • Report on payer performance and emerging models of care to senior management along with recommended course of action.
  • Provide strategic financial direction in support of key strategic initiatives for long-range financial planning, capital expenditures and budgeting.
  • Participate as leader within System contracting function in setting strategic course of all contracting strategies and revenue opportunities.
  • Participate on executive level with healthcare associations and other committees, as appropriate
  • Serve as the VP of Contracting and Payer Relations for PSJH in all regions, and specifically serves as the Chief Administrator for the contracting team in the Northern regions of the system, including Alaska, Montana, Washington, and Oregon.  Works in partnership with the VP of Contracting and Network Development who will have responsibility for the contracting team in the Southern regions, California, Texas, and New Mexico.
QUALIFICATIONS
Required education/experience for this position include:
  • Bachelor's degree required, preferably in healthcare administration, finance, business, or related field.
  • Master's degree in Business Administration (MBA), Health Administration (MHA) (or equivalent ...

Swedish Medical Center

Address

Irvine, CA
USA

Industry

Business

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