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Director-Payor Strategy in Spartanburg, SC at Spartanburg Regional Healthcare System

Date Posted: 5/2/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    5/2/2019

Job Description

Position Summary

The Director, Payor Strategies and Relations is a key position of a dynamic leadership team responsible for leading negotiations and relationships with payors.   The Director will provide significant contribution to the development of Spartanburg Regional’s managed care strategy, including migration to value based contracts.

Minimum Requirements

Education          

  • BS/BA

Experience         

  • Minimum of 7 years’ experience with progressive responsibility in the health care environment, provider or payor, at least 5 of which should be in a managed care position with demonstrated competencies or an equivalent combination of experience and education
  • Strong results orientation. 
  • Ability to build and lead a high performing team
  • High degree of focus on improving data and analytics capabilities to drive critical decisions.
  • Ability to identify new processes and/or systems to improve productivity and results.
  • Value on excellence

Skills, Abilities, and Characteristics

STRATEGIC THINKER

  • Critically evaluates both regional and national market dynamics and healthcare reform and formulates hypothesis or alternative scenarios to determine the impact the company.
  • Translates Spartanburg Regional's business goals into detailed plans for managed care and clearly articulate them to the market and payors.
  • Thinks about both short and long term goals.
  • Utilizes a give-and-take approach when negotiating with payors.
  • Spends time identifying all stakeholders necessary and meets or connects with all of them, neglecting no one to shape a collective consensus.
  • Identifies opportunities to build relationships that will help others achieve their objectives and reaches out to those people or new people.
  • Gathers information about payor needs and requirements, by studying data and speaking with the market, understanding the health plan business from their perspective.
  • Uses analytics to identify opportunities for improved performance.

CHARACTERISTICS:

  • Data driven; willing to roll up one's sleeves
  • Organizational, problem-solving, and analytical skills
  • Self-motivated, flexible, with strong interpersonal/communication skills
  • Excellent independent judgment and decision-making skills
  • Excellent oral, written, and relational communication skill
  • Exudes confidence. Is collegial, self-aware, humble and open to feedback

Preferred Requirements

Preferred Education      

  • Masters

Preferred Experience    

  • Healthcare experience for a payor or provider.  Integrated delivery system experience preferred.
  • Knowledge of managed care market.
  • High degree of advanced financial analytical skills with specific application to all aspects of managed care negotiations / dashboards on behalf hospitals, physicians, ancillary providers and PHOs. 
  • Strong organizational skills.
  • Demonstrated success in leading, implementing and managing managed care strategies.
  • Demonstrated ability to work effectively in a matrix-oriented organization.
  • Excellent technical skills with strong emphasis on accuracy.
  • Experience leveraging traditional technology systems as well as emerging technologies to support the capture and analysis of data.
  • Experience with advanced data techniques including advanced qualitative and quantitative data mining, complex predictive modeling and other real-time pattern detection methods.
  • Ability to work independently

Core Job Responsibilities

  • Key leader in the development of SRHS's comprehensive payor / managed care strategy
  • Key leader and driver in the development of SRHS’s payor/managed care analytics and data base management capabilities, including contract negotiation analytics, portfolio dashboard, trends report and population health reports.   Data will originate from internal (EMR based) and external (payor claim data) sources
  • Establishes strong relationships with Regional Health Plus (SRHS’s Physician Hospital Organization) and Southeastern Health Partners (SRHS’s regional ACO) leadership and staff.  
  • Establish innovative provider relationships that promote new programs, expand market share and generate revenue growth
  • Research and prepare the organization in collaboration with applicable functional leaders for federal/state health reform, changes in regulatory requirements, new payor products and reimbursement methodologies
  • Lead development of sophisticated contract models in support of payor negotiations
  • Proactively meet with payors to develop strong relationships resulting in new opportunities for collaboration and partnership.
  • Manage SRHS's managed care financial portfolio and identify opportunities for trends, revenue improvement, market share growth, and improved operational efficiency
  • Plan, organize, and conduct managed care negotiations with payors in accordance with SRHS goals and objectives and direction by SVP of Payor Strategy and Population Health
  • Develop and implement a proactive payor communications strategy
  • Develop and implement processes to insure timely implementation of managed care agreements with current and prospective payors on behalf of SRHS and Regional Health Plus  and Southeastern Health Partners ACO.
  • Contribute to definition of SRHS's population health strategy. 
  • Insure contracts support opportunities for improved margin, market share, and collaboration with affiliated providers.
  • Analyze the financial viability of payor relationships and coordinate with hospital quality staff to evaluate clinical outcomes, operational effectiveness and service excellence. 
  • Develop pricing methodologies in support of new programs or clinical business planning (i.e. bundles, centers of excellence, etc.)
  • Develop financial models to clearly identify population-specific drivers of utilization and cost for risk-based contracts and identifying actionable leverage points for impacting these drivers
  • Other duties as assigned