Region Director Payer Strategy

Commonspirit; Lexington (KY); Remote; USD 100,000 - 125,000; Full time

Job summary

CommonSpirit Health seeks a Market Director for Payer Strategy, responsible for managed care policies and payer relationships. This remote role, preferred for candidates in KY or TN, is crucial for financial performance and involves strategic decision-making. Applicants should have a Bachelor’s degree and substantial experience in healthcare or managed care.

Qualifications

• Minimum 5 years in healthcare or managed care industry.
• At least 4 years of leadership experience.

Responsibilities

• Responsible for managed care policies, contract language, and negotiations.
• Builds relationships with payers and drives market strategy.
• Stays current with payer trends and manages detailed information.

Skills

Negotiation

Contract Management

Financial Analysis

Problem Assessment

Interpersonal Skills

Education

Bachelor’s Degree in payer strategy or managed care

Job description

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Responsibilities

This is a remote position with a strong preference for someone in the KY or TN area.

The Market Director, Payer Strategy and Relationships (PSR), is responsible for managed care policies, goals, objectives related to contract language and reimbursement, negotiation strategy, and payer relationships. The Director collects and communicates Market-level insight and strategic knowledge to/from the PSR National Payer teams, the PSR Growth & Innovation team, and other key departments across the enterprise. This position is essential to CommonSpirit Health’s financial performance and has significant impact on the organization’s long-term strategic trajectory. The role involves securing optimal fee-for-service and value-based reimbursement, protecting the interests of hospitals/ancillaries/professional providers in contract negotiations, and strengthening payer relationships.

• Participates in developing Market strategy, relationships, and contracts with local and national payers to drive negotiation strategy, reimbursement structure, contract renewal planning, and implementation. Budgeted performance and growth targets set by senior leaders are integral.
• Gathers information and guidance from Division PSR VP, ministry leaders, internal stakeholders, and financial analysis to align with Market needs and communicates proactively with the PSR National Payer teams.
• Establishes and maintains positive, strategic relationships with payers, employers, providers, and leaders. Maintains relationships with National Payer contacts within the Market, including appropriate Center of Excellence (COE) Designations.
• Develops and executes communication plans and Payer Negotiation Outlines related to payer relationships, negotiations, contractual obligations, and market developments including Fee-For-Service and Value-Based Agreements, supporting the Healthier Communities strategy.
• Makes independent decisions based on appropriate information and objectives, manages detailed information, and carries responsibility for planning and control.
• Stays current with emerging payer trends, reimbursement methodologies, regulatory issues, plan benefits, payer activities, products, delivery channels, and market competition.
• Supports strategic objectives related to IDNs, population health, and care management.

Qualifications

Required Experience and Education

• Bachelor’s Degree or equivalent experience in payer strategy, managed care, or provider network senior roles.
• Minimum of five (5) years in healthcare or managed care industry.
• Minimum of four (4) years of leadership experience.

Required Knowledge, Skills, Abilities, and Training

• Knowledge of provider and payer industry.
• Problem assessment and solution implementation skills.
• Extensive knowledge of contractual, administrative, insurance, and operational issues related to managed care organizations, physicians, hospitals, and insurance plans.
• Technical skills in negotiation, contract management, financial analysis, and reimbursement methodologies.
• Ability to prioritize in dynamic environments, work independently, and own projects.
• Self-motivated, driven, and excellent interpersonal, verbal, and written communication skills.

Overview

Inspired by faith, driven by innovation, powered by humankindness, CommonSpirit Health is building a healthier future through integrated health services. As a large nonprofit Catholic healthcare organization, it delivers over 20 million patient encounters annually across clinics, hospitals, and virtual care, with over 157,000 employees across 24 states. The organization contributes more than $4.2 billion annually in community benefits.

Pay Range

$56.56 - $82.01/hour

Additional Details

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Wellness and Fitness Services, Hospitals and Health Care, Medical Practices

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