Senior Director, Payor Contracting

Community Care Cooperative; Boston (MA); On-site; USD 139,000 - 173,000; Full time

Job summary

Community Care Cooperative (C3) in Boston, MA is seeking a Senior Director of Payor Contracting to lead contracting strategy for value-based arrangements across markets. This role partners with the Executive Team to grow and optimize payor relationships and contract performance.

The position requires healthcare contracting experience, a Bachelor’s degree (post-graduate preferred), and 7–10 years of relevant work. Travel may be required as part of market expansion.

Qualifications

• Strong analytical skills and healthcare contracting experience.
• Experience with Federally Qualified Health Centers (FQHCs) and risk-based contracts is preferred.
• Excellent written and oral communications to senior leadership are required.

Responsibilities

• Lead payor and provider contracting strategy across multiple markets with the Executive Team.
• Identify opportunities for value-based contracts with FQHC partners and assess expansion capacity.
• Manage strategic initiatives for new markets and contract terms.
• Develop and maintain relationships with health plans and provider organizations to meet contracting objectives.
• Coordinate with analytics and actuarial teams to project P&L from value-based contracts.
• Ensure contract compliance and communicate requirements to leadership and partners.
• Oversee implementation of new payor contracts and monitor success.

Skills

Strong analytical skills

Healthcare experience

FQHC contracting knowledge

Excellent written & verbal comms

Education

Bachelor’s degree

Post-graduate degree in health care, business, law, or finance

Job description

Full Time Boston, MA, US

Salary Range: $138,767.00 To $173,458.00 Annually

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the MassHealth ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide.

As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.

We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

Under the direction of the Vice President of Corporate Strategy & ACO Contracting and in partnership with Executive Leadership, the Senior Director, Payor Contracting is responsible for contributing to the organization’s success in managing the organization’s business development efforts in the areas of new value-based contracts and provider contracting.

Responsibilities:

• Lead the organization’s payor and provider contracting strategy across multiple markets in partnership with the Executive Team
• Identify opportunities for new value-based contracts on behalf of Federally Qualified Health Center partners and assess both the Company’s and FQHCs capacity to expand into new markets
• Manage key strategic initiatives related to the organization’s payor contracting strategy, including entry into new geographic areas and markets
• Develop and maintain partner relationships with health plans and provider organizations to meet the organization’s contracting objectives
• Assist in the development and management of C3’s business development efforts related to value-based contracting
• Work with the National Strategy team to research, identify and negotiate value-based contracting opportunities in new markets across multiple payors
• Negotiate with payors and oversee the procurement of new payor contracts, principally risk-based contracts
• Partner with analytics and actuarial teams to understand and predict P&L from new value-based contracts
• Maintain communications with all stakeholders in the contracting process, including payors, C3 Leadership, and Federally Qualified Health Center partners
• Understand and communicate contractual requirements and in coordination with leadership, ensure compliance on contract terms
• Conduct due diligence on new contract terms and assist in future gain/loss projections
• As necessary, work with Operations, Clinical Operations, Quality, Risk Adjustment, and other departments as appropriate to ensure broad-based understanding of contract requirements
• As necessary, assist in the implementation of all new payor contracts
• Participate in the monitoring of success in the organization’s value-based contracting efforts
• Some business travel may be required
• All other duties as assigned
  

Required Skills:

• Strong analytical skills
• Healthcare experience required, including experience with value-based contracts strongly preferred
• Experience with Federally Qualified Health Centers, including their Federal financing structure, preferred
• Excellent written and oral communications to a senior leader audience, including the ability to present complex situations and financial analysis in a clear and concise manner

Desired Other Skills:

• Track record of facilitating diverse stakeholders toward shared recommendations
• Familiarity with value-basedcontracts
• Familiarity with Federally Qualified Health Centers
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:

• Bachelor’s Degree required
• Post-graduate degree in health care, business administration, law, or finance field preferred
• 7-10 years of professional experience strongly preferred
• Experience in health plan and/or provider network contracting required, 5-7 years strongly preferred

** In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **