Providence is calling a Vice President of Contracting and Payer Relations to Providence System Office in Various Locations. "May maintain a central office location in either Renton, WA; Portland, OR, or Irvine, CA with satellite offices where staff is located in each of the respective locations (including Montana and Alaska)."
This system-wide 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.
In this position you 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
- 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.
- 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.
Required qualifications 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 experience) required [Other advanced degrees may be considered depending on experience – JD, Ph.D., MD].
- Minimum ten years of experience in health care.
- Minimum 7 years of leadership experience with accountability for managing a team.
- Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.
- Minimum five years' experience working in a managed care environment on either the payer or provider side.
- Experience with Medicare Advantage and other Government programs preferred.
Providence Health & Services (Providence) is a not-for-profit Catholic health care ministry committed to providing for the needs of our communities—especially for those who are poor and vulnerable. Providence's scope of services includes 34 hospitals, 600 physician clinics, senior services, supportive housing, health plans and many other educational and social services. The health system employs more than 82,000 caregivers (all employees) across five states—Alaska, California, Montana, Oregon and Washington—with its system office located in Renton, Washington. Providence is the fourth largest not-for-profit health care delivery system in the country with combined revenues of over $14 billion.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Leadership
Req ID: 153614