Assistant Director, Payer Contracting and Business Development

Cleveland Clinic

21h•Remote

About The Position

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. The Assistant Director Business Development and Payer Contracting partners with leadership to develop and implement payer contracting and business development growth strategies and processes, payer operations processes. In this position, you will manage relationships with third-party payers, community physicians, and employers. Works with partners to develop analytics to support contract negotiation, growth strategies, risk capture, population health and contract analysis and implementation efforts as well as product strategies and payer operations. A caregiver in this role works remotely from 8:00 a.m. – 5:00 p.m. Candidates for this position are preferred to reside in Ohio, Nevada, or Florida. A caregiver who excels in this role will: Analyze markets from a strategic perspective, develop managed care strategies and tactics by market, nationally and at the state level. Provide work direction and leadership to regional and national caregivers teams within MNS to support the following lines of business including but not limited to: Medicaid, transplants, centers of excellence, regional PPOs, and single case agreements. Develop and implement market and network services goals including but not limited to managed care contracting goals and objectives ensures their execution. Recommend and gain support from MNS leadership, institute leaders and operations to ensure optimal implementation of the business development and managed care contracting strategies. Maintain awareness of market, payer, and competitive managed care activities and adjust strategies accordingly. Work with contract managers, operations, and clinical caregivers to ensure effective implementation of new and renegotiated contracts and to resolve problem payer issues. Communicate effectively with leadership, operations, and contract managers on the status of contracting and problem payer issues. Review and negotiate contract language and pricing terms in accordance with budgetary objectives and policy and procedures to maximize benefit to the company. Represent the company to payers and regulatory authorities in matters related to payer account management. Manages not less than 1/3 of the net reimbursement from managed care payers. Effectively communicates trends and issues to corporate managed care through ad hoc communications, monthly and quarterly reports. Work with corporate managed care to recommend changes in contracting and reimbursement guidelines to ensure achievement of reimbursement maximization as it relates to managed care. Develop playbooks for contracting segments including but not limited to transplant, vision, dental, behavioral health, and value-based contracting to aid in the development of the contract managers and senior contract managers.

Requirements

Bachelor’s degree in Finance, Accounting, Business, or Healthcare Administration or related field.
Ten years healthcare management experience in a managed care environment.
Extensive knowledge of healthcare planning, finance, marketing, reimbursement, operations, and related activities.
Experience leading process improvement activities across cross functional teams and organization

Nice To Haves

Master’s degree
Experience managing contracts for regional systems offering comprehensive services
Experience working with various insurance plans and diverse healthcare services

Responsibilities

Analyze markets from a strategic perspective, develop managed care strategies and tactics by market, nationally and at the state level.
Provide work direction and leadership to regional and national caregivers teams within MNS to support the following lines of business including but not limited to: Medicaid, transplants, centers of excellence, regional PPOs, and single case agreements.
Develop and implement market and network services goals including but not limited to managed care contracting goals and objectives ensures their execution.
Recommend and gain support from MNS leadership, institute leaders and operations to ensure optimal implementation of the business development and managed care contracting strategies.
Maintain awareness of market, payer, and competitive managed care activities and adjust strategies accordingly.
Work with contract managers, operations, and clinical caregivers to ensure effective implementation of new and renegotiated contracts and to resolve problem payer issues.
Communicate effectively with leadership, operations, and contract managers on the status of contracting and problem payer issues.
Review and negotiate contract language and pricing terms in accordance with budgetary objectives and policy and procedures to maximize benefit to the company.
Represent the company to payers and regulatory authorities in matters related to payer account management.
Manages not less than 1/3 of the net reimbursement from managed care payers.
Effectively communicates trends and issues to corporate managed care through ad hoc communications, monthly and quarterly reports.
Work with corporate managed care to recommend changes in contracting and reimbursement guidelines to ensure achievement of reimbursement maximization as it relates to managed care.
Develop playbooks for contracting segments including but not limited to transplant, vision, dental, behavioral health, and value-based contracting to aid in the development of the contract managers and senior contract managers.