Region Director Payer Strategy

Commonspirit; Rancho Cordova (CA); On-site; USD 100,000 - 125,000; Full time

Job summary

An established industry player is seeking a Region Director for Payer Strategy to lead managed care policies and negotiations. This remote role, ideally suited for candidates in California, requires extensive experience in the managed care industry and a strong understanding of payer relationships. The successful candidate will drive strategic initiatives, optimize reimbursement structures, and enhance partnerships with health plans. Join a mission-driven organization dedicated to improving community health and well-being, where your expertise will significantly impact the financial performance and strategic direction of the organization. If you are passionate about healthcare and ready to make a difference, this opportunity is for you.

Qualifications

• 5+ years in managed care strategy and negotiations.
• Experience in leadership and supervisory roles.

Responsibilities

• Develop and execute negotiation strategies with payers.
• Maintain relationships with payers and internal stakeholders.
• Analyze and establish coverage for market populations.

Skills

Negotiation Skills

Financial Analysis

Contract Preparation

Problem Solving

Interpersonal Skills

Education

Bachelor’s Degree

Job description

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Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

This is a remote position with a strong preference for someone to be located in California and have California managed care experience.

The Regional Director, Payer Strategy and Relationships (PSR), is responsible for managed care policies, goals and objectives related to contract language and reimbursement (capitation, fee-for-service, and quality incentive programs), negotiation strategy, and payer relationships for all Physician Enterprise and hospital-based clinic physician entities across California. There are currently 12 Medical Groups with 160+ clinic sites and over 5,000 physicians in our medical networks. It is preferred that the candidate resides in the California market and must have extensive experience working with California health plans and IPAs. The Regional Director is primarily focused on payer relationships and health plan contracting for all managed care lines of business and collects and communicates Region-level insight and strategic knowledge to/from the PSR National Payer teams, Physician Enterprise, 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 long-term strategic trajectory of the organization. This position secures optimal fee for service and value-based reimbursement, protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations, and strengthens CommonSpirit Health’s relationships with payers.

Key Responsibilities

• Participates in the development of regional strategy, relationships, and contracts with local and national payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation.
• Gathers information and guidance from Regional PSR VP, ministry leaders, internal stakeholders, and financial analysis relative to the strategic, operational, financial needs and expectations of the CA Region related to the National Payers; proactively communicates with the PSR National Payer teams.
• Establishes, builds, and maintains positive, strategic interactions and relationships with payers, employers, providers, and leaders across the ministry.
• In collaboration with Regional Leadership and other PS&R Leadership, develops and executes communication plans and Payer Negotiation Outlines related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
• Makes independent decisions and/or exercises judgment based upon appropriate information and objectives.
• Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges, market competition, etc.
• Supports the strategic objectives of CommonSpirit Health’s IDNs, population health, and care management initiatives through directly engaging local payers and employer customers.
• Participates in and contributes to CommonSpirit Health’s PSR knowledge base through sharing best practices, developing contract performance goals, key metrics, new analytical tools, network development, reimbursement and language guidelines, revenue realization, and other applicable work streams.
• Represents Physician Enterprise entities in Provider Excess bidding process with broker each year to analyze and establish appropriate coverage for each market population.
• Participates in the dispute resolution and denials processes with local payers if the materiality exceeds $1M.
• Leads and organizes sub-projects necessary to support local and national payer negotiations and growth.

Qualifications

Education And Experience

• Bachelor’s Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree.
• Minimum of five (5) years of recent experience in the managed care industry with responsibility for strategy and negotiations.
• Minimum of four (4) years of leadership and supervisory experience.

Required Minimum Knowledge, Skills, Abilities, Training

• Working knowledge of provider and payer industry.
• Strength in assessing problems and implementing solutions.
• Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.
• Proven and extensive technical skills, negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies for both fee for service and value-based contracts.
• Demonstrated ability to set and maintain multiple priorities in an environment with shifting priorities, while providing accurate deliverables in a timely fashion.
• Strength in self-motivation and ability to assume ownership of assignments and projects. Driven to succeed.
• Strong interpersonal, verbal, and writing skills in dealing with payers, guests and team members.

Pay Range
$59.53 - $94.00 /hour

Seniority level

• Not Applicable

Employment type

• Full-time

Job function

• Health Care Provider
• Industries: Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices