Director, Contracting

Point32Health Services; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Point32Health is seeking a Director of Contracting to lead contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems across multiple markets and products.

The Director will head a team of contract managers, foster strategic provider relationships, and ensure contracts support membership growth, quality outcomes, and financial performance.

Qualifications

• Bachelor's degree required in business, health care or related field.

Responsibilities

• Provider Network Strategy and Development: Develop provider networks to meet goals for access, membership, quality, medical cost, and earnings; build and maintain high performing networks with risk-based incentives.
• Contract Negotiation and Management: Direct a team to negotiate financial, operational, regulatory, and legal contract parameters with physician groups, ACOs, and hospitals; support strategy and negotiations.
• Strategic Relationship Management: Develop proactive relationships with strategic providers; monitor performance and advise on improvement plans.
• Stakeholder Engagement: Communicate with function leaders; participate in leadership meetings on provider strategy and network development.
• Talent Management and Team Building: Coach staff in negotiation, performance analysis, and relationship management to build a high-performing team.

Education

Bachelor's degree in business, health care or related field

Job description

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health .

Job Summary

The Director of Contracting is responsible for contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems across multiple markets and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for membership growth, quality, and financial performance. The Director will foster and maintain strong relationships with strategic providers to support achievement of shared plan and provider objectives. The Director is member of the leadership team and will be actively engaged in division strategy, planning and performance initiatives. This role will manage a team of contract managers and will work in a matrix environment collaborating with functions including risk adjustment, population health, finance, operations, actuarial, and sales.

Job Description

Key Responsibilities/Duties - what you will be doing (top five):

• Provider Network Strategy and Development

  Develop provider networks to meet goals for access, membership, quality, medical cost, and earnings. Build and maintain high performing provider networks utilizing risk-based structures and incentives whenever possible. Identify and recommend changes to networks as needed to advance business goals. Collaborate with VP and President to develop network strategies, risk sharing and payment models, and performance incentives to support achievement of cost and quality goals. Stay abreast of trends and changes in the industry, provider landscape, and federal and state payment policies and methodologies. Utilize this knowledge to refine and advance network development and performance.

• Contract Negotiation and Management

  Direct a team of contract managers to negotiate financial, operational, regulatory, and legal contract parameters with physician groups, ACOs, and hospitals to meet business goals and regulatory timelines. Coach, support, and train staff to devise proposals, strategies, and options for contract negotiation. Support contract negotiation as needed. Devise strategy, lead and negotiate agreements with largest provider systems. Develop and maintain optimal provider networks. Assess, monitor, and manage network adequacy to meet federal and state regulations. Proactively identify and close network gaps. Collaborate with Enterprise Allied Health Contracting to ensure allied health and BH/SA networks and payment terms support Medicare division needs and goals. Assess and monitor allied payment rates and recommend changes to methodology and rates to align incentives and manage expense trends. Collaborate with colleagues in the Enterprise Network Operations to ensure timely and accurate contract implementation, configuration, and accurate ongoing contract administration.

• Strategic Relationship Management

  Develop and implement a proactive relationship management approach that supports long-term, mutually successful relationships with strategic providers. Engage with the provider performance team to understand and monitor provider and network performance. Advise on performance improvement plans and identify contract strategies and incentives that support performance improvement. Collaborate with operations, professional relations, and other functions to identify and resolve provider issues.

• Stakeholder Engagement

  Proactively communicate and engage with function leaders and key stakeholders. Participate in/chair leadership meetings concerning provider strategy, network development and other issues.

• Talent Management and Team Building

  Provide ongoing staff development and coaching in negotiation, performance analysis, and relationship management to enable a high-performing team of provider professionals.

• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

Education

Required (minimum): bachelor's degree in business, health care or related field.

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