REMOTE Sr. Managed Care Contracting Consultant

Trinity Health•Livonia, MI

22h•Remote

About The Position

Provides managerial direction, leadership, consultation project management and specialized expertise in the delivery of large, complex and highly visible major payer contracting project initiatives and negotiations for Trinity Health at a System level for national payer contracts or at a regional market level for regional payers. Additionally, provides managerial direction, leadership, consultation, project management and expertise for problem-issue resolution for major national or regional Managed Care payers. Provides strategic leadership in negotiating arrangements with HMO, PPO and other major payer contracting entities in the areas of price negotiations, settlements, project management and evaluation of financial performance, among others. Leads activities in strategy development, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution. Executes managed care strategies developed jointly with Regional Health Ministries (RHM) and System Office leadership. Work assignments involve significant project management, critical relationship, collaborative and consensus building skills while managing relationships between payers, providers and its shared services customers. Work assignments and responsibility require in-depth knowledge of managed care contracting and payer-provider relationships. Serves as a subject matter expert by providing contracting guidance and problem/issue resolution to internal colleagues on matters impacting projects and day-to-day assignments.

Requirements

Bachelor’s degree in Public Health, Business Administration, Finance, Accounting, Economics, Informatics or related field.
Requires a breadth and mastery of analytic and business knowledge in multiple disciplines/processes.
Seven (7) to ten (10) years of progressively responsible operational (management), project management or consulting experience in managed care analytics, medical economics reporting, product development or population health analytics or an equivalent combination of education and work experience.
Significant experience and proven results regarding complex project management or consulting experience in managed care analytics, medical economics reporting, and product development or population health analytics.
Significant experience gained from health plan, health system, the healthcare industry or a provider health network is required.
Demonstrated ability to lead and manage with frequent changes in departmental priorities.
Proven track record of effectively managing progressively large complex projects, which include the management of vendor relationships and multiple technology and analytic solutions to achieve a single business objective with proven successful delivery results.
Excellent program leadership, organization, integration and execution skills and abilities.
Extensive experience in planning, formulating and executing strategies, as well as the ability to define program, process or business objectives and scope.
Demonstrated proficiency and expertise to identify, evaluate and articulate operational opportunities, business needs and gaps, plan and implement steps, understand stakeholder interest and provide authoritative consultation.
Proven customer-service orientation.
Ability to know and understand customer requirements and exercise judgment in meeting reasonable expectations, particularly when differences of opinion on needs and services, unanticipated contingencies or divergent ideas and perspectives exist.
Strong interpersonal and relationship building skills with proven ability to initiate and develop productive collaborative partnerships with executive leaders, management, associates, and customers, along with effective vendor interface/management experience.
Ability to drive positive results in difficult situations and effectively respond to multiple, ever-changing and competing priorities.
Formidable facilitation skills to lead and influence diverse member interests, teams and groups through strong leadership, communication, collaboration, negotiation and intuitive abilities.
Ability to shape results, garner support and successfully manage complex relationships and influences within and across the organization.
Excellent oral and written communication, negotiation and presentation skills.
Ability to translate and present technical information to clinical and operations staff (and vice versa).
Ability to facilitate communication between diverse groups and interests, to effectively identify, assess and advance improvements and resolutions, and to provide advisory, consultative and authoritative recommendations to all levels of the organization.
Working knowledge of project management, change management, process improvement methodologies, and/or executive coaching.
Ability to operate in an ambiguous and highly matrix organizational structure.
Ability to operate in a highly autonomous self-directed manner under frequently changing structures and requirements and work priorities.
Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.

Nice To Haves

Master's or Doctoral degree preferred.
Previous managerial experience preferred.

Responsibilities

Leads and maintains business owner responsibility for projects of all sizes.
Defines and manages project plans and goals; conducts business workflow mapping; impact analyses and modeling; applies action steps, develops status reports or communication plans and keeps senior executives, management and key stakeholders apprised ensuring project plans and deliverables are met and in alignment with organization goals.
Provides a leadership advisory role in problem solving, responding to challenges and potential risk factors and assists in identifying, understanding and utilizing process improvement methodologies.
Establishes strategies and goals for colleagues, manages resources within budget targets, coordinating allocation of staff resources assigned to achieve optimal outcomes.
Performs all managerial tasks associated with effective day-to-day operations of a team of individuals and the PS&PD function.
Mentors, leads and helps train analysts; facilitates learning for other centralized and regional colleagues collaborating on payer strategy programs.
Directs the processes and guidelines around the configuration and maintenance of applicable Analytic Platforms.
Develops reporting tools and dashboards for executive management using these systems and analytic tools.
Serves as a seasoned, knowledgeable resource providing an extensive understanding of strategic issues and tactical initiatives and ensuring processes, workforce, technology and culture factors are addressed in enterprise, RHM, and System Office plans.
Develops recommendations that provide practical options and tactical solutions while considering the impact on processes, workforce, technology and culture.
Provides guidance to senior leaders regarding systems and processes for which they are responsible.
Works to ensure alignment in terms of organizational priorities, adequate funding, executive sponsorship, business owner support, staff resources and financial stewardship goals.
Applies operational improvement methodologies (i.e., change management techniques, management principles, process redesign, executive coaching, etc.) or systems implementation methodologies to achieve needed outcomes.
Establishes and prioritizes objectives to align with budget, resources and timing.
Oversees and participates in multiple cross-functional teams to ensure that key initiatives are completed within budget, within scope and on time.
Monitors, measures and reports on budget variances, resource constraints and operational issues.
Manages executive relationships to ensure active and focused engagement throughout initiatives.
Participates in senior level forums and facilitates meetings and work groups to develop strategies, establish standards and resolve issues.
Collaborates with leadership and key stakeholders to influence outcomes, remove barriers and resolve issues.
May represent executive leader in various meetings.
Apprises executive leaders and other key stakeholders of meeting content and outcomes.
Serves as an escalation point for System Office and RHM concerns.
Establishes and maintains on-going effective relationships and communication to customers, senior leadership, managers, stakeholders, staff and partner/vendor organization related to projects, new opportunities, and standardization opportunities.
Facilitates a coordinated communication plan for internal and external audiences in order to foster a greater understanding of the benefits and value of the System objectives as well as other accomplished initiatives.
Develops and implements strategies that incorporate business needs and requirements, industry trends and technology solutions which facilitates the achievement of strategic and financial objectives.
Oversees or directs the integration of vendor tasks and vendor deliverables.
Leads or participates in vendor negotiations for products and services.
Manages vendor service issues and maintains effective relationships.
Maintains a working knowledge of applicable Federal, state and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.