REMOTE Regional Director of Payer Strategies & Contract - MICHIGAN REGION
Employment Type:
Full timeShift:
Day ShiftDescription:
oNegotiates FFS & APM managed care contracts with PCOC level payers.
Provides senior-level leadership for the TH PSPD Central Service Area.
Directs activities for strategy development, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution.
Michigan Experience Highly Preferred Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
Develops and executes managed care and commercial payer strategies in conjunction with RHM CFOs and CEOs within region.
Negotiates regional managed care and commercial payer contracts utilizing consistent language and reimbursement methodologies and ensures that contracts are aligned with RHM strategies.
Establishes and maintains active, positive relationships with senior leadership at the hospitals, Revenue Excellence leadership, System Office leadership and Trinity Health Legal to ensure communication regarding service level performance and issue resolution.
Operationalizes and implements managed care contracts and contract updates at hospitals and within Revenue Excellence, including monitoring programs and denial management programs.
Communicates and implements payer policy changes with hospitals and Revenue Excellence.
Monitors compliance with payer requirements and provides additional training when needed.
Monitors payer financial and operational performance and proactively implements payer corrective actions and improvement activities when required.
Establishes and maintains active, positive relationships with payer senior leadership with contracted payers within region.
Identifies opportunities for payer collaboration and implements collaborative programs.
Serves as liaison between hospitals and payers within region.
Provides regular payer reporting package, including payer report cards, to hospital C-Suite leaders and Revenue Excellence leadership.
Develops and maintain market profiles of key payers, buyers and brokers to assist in developing strategies, decision making and proactively identifying managed care and health insurance trends.
Develops, implements and monitors payer pay for performance initiatives.
Works with clinical leadership at hospitals to ensure maximum realization of revenue.
Manages and mentors payer contracting staff within region.
Prepares budgets and manages use of resources within budget targets.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
LEADERSHIP COMPETENCIESAs a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:
Mission Statement:
We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
CORE VALUES:
Reverence:
We honor the sacredness and dignity of every person.
Commitment to Those who are Poor:
We stand with and serve those who are poor, especially those most vulnerable.
Justice:
We foster right relationships to promote the common good, including sustainability of Earth.
Stewardship:
We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
Integrity:
We are faithful to those we say we are.
Michigan Experience Highly Preferred MINIMUM QUALIFICATIONS Must possess a comprehensive knowledge of healthcare finance, managed care and insurer contracting, normally obtained through completion of a Bachelor's in Business Administration, and eight to ten years of healthcare experience, a significant portion of which should include working with managed care and other payers.
Master's on Business Administration or Master's in Health Administration preferred along with professional certification such as FHFMA, FACHE, or FAHM.
Must possess proven contract negotiation knowledge and skills.
Must possess strong analytical skills.
Must possess strong written and verbal communication skills.
Must be able to operate effectively in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Compensation Range:
$80.
00 - $132.
00 (hourly)PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS Must be able to adapt to frequently changing work priorities, and be able to prioritize and balance the requirements of working with the System Office and Regional Health Ministries (RHMs).
Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Must be able to travel to the various Trinity Health sites within region (40%) as needed.
Must possess the ability to comply with Trinity Health policies and procedures.
Our Commitment to Diversity and InclusionTrinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states.
Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes.
We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Recommended Skills Adaptability Analytical Business Administration Clinical Works Coaching And Mentoring Communication Estimated Salary: $20 to $28 per hour based on qualifications.
Full timeShift:
Day ShiftDescription:
oNegotiates FFS & APM managed care contracts with PCOC level payers.
Provides senior-level leadership for the TH PSPD Central Service Area.
Directs activities for strategy development, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution.
Michigan Experience Highly Preferred Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
Develops and executes managed care and commercial payer strategies in conjunction with RHM CFOs and CEOs within region.
Negotiates regional managed care and commercial payer contracts utilizing consistent language and reimbursement methodologies and ensures that contracts are aligned with RHM strategies.
Establishes and maintains active, positive relationships with senior leadership at the hospitals, Revenue Excellence leadership, System Office leadership and Trinity Health Legal to ensure communication regarding service level performance and issue resolution.
Operationalizes and implements managed care contracts and contract updates at hospitals and within Revenue Excellence, including monitoring programs and denial management programs.
Communicates and implements payer policy changes with hospitals and Revenue Excellence.
Monitors compliance with payer requirements and provides additional training when needed.
Monitors payer financial and operational performance and proactively implements payer corrective actions and improvement activities when required.
Establishes and maintains active, positive relationships with payer senior leadership with contracted payers within region.
Identifies opportunities for payer collaboration and implements collaborative programs.
Serves as liaison between hospitals and payers within region.
Provides regular payer reporting package, including payer report cards, to hospital C-Suite leaders and Revenue Excellence leadership.
Develops and maintain market profiles of key payers, buyers and brokers to assist in developing strategies, decision making and proactively identifying managed care and health insurance trends.
Develops, implements and monitors payer pay for performance initiatives.
Works with clinical leadership at hospitals to ensure maximum realization of revenue.
Manages and mentors payer contracting staff within region.
Prepares budgets and manages use of resources within budget targets.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
LEADERSHIP COMPETENCIESAs a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:
Mission Statement:
We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
CORE VALUES:
Reverence:
We honor the sacredness and dignity of every person.
Commitment to Those who are Poor:
We stand with and serve those who are poor, especially those most vulnerable.
Justice:
We foster right relationships to promote the common good, including sustainability of Earth.
Stewardship:
We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
Integrity:
We are faithful to those we say we are.
Michigan Experience Highly Preferred MINIMUM QUALIFICATIONS Must possess a comprehensive knowledge of healthcare finance, managed care and insurer contracting, normally obtained through completion of a Bachelor's in Business Administration, and eight to ten years of healthcare experience, a significant portion of which should include working with managed care and other payers.
Master's on Business Administration or Master's in Health Administration preferred along with professional certification such as FHFMA, FACHE, or FAHM.
Must possess proven contract negotiation knowledge and skills.
Must possess strong analytical skills.
Must possess strong written and verbal communication skills.
Must be able to operate effectively in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Compensation Range:
$80.
00 - $132.
00 (hourly)PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS Must be able to adapt to frequently changing work priorities, and be able to prioritize and balance the requirements of working with the System Office and Regional Health Ministries (RHMs).
Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Must be able to travel to the various Trinity Health sites within region (40%) as needed.
Must possess the ability to comply with Trinity Health policies and procedures.
Our Commitment to Diversity and InclusionTrinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states.
Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes.
We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Recommended Skills Adaptability Analytical Business Administration Clinical Works Coaching And Mentoring Communication Estimated Salary: $20 to $28 per hour based on qualifications.
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