REMOTE Sr. Managed Care Contracting Consultant

Trinity Health•Livonia, MI

1d•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. Some travel is required. 1. Knows, understands, incorporates, and demonstrates the mission, vision, and values of Trinity Health in leadership behaviors, practices, and decisions. 2. Conducts complex language and financial analysis with major payers. Deploys managed care contract strategy for hospitals, ancillaries, physician and other RHM services. Implements legal, financial and business requirements and objectives thorough project management and negotiations. 3. Provides consulting services, expertise and project management skills in major contracting and problem-issue resolution to RHM executive and PSPD leadership to improve the revenue base of the RHM, accelerate cash flows, decrease bad debt, and improve accuracy of revenue reporting. 4. Leads activities in strategy development, project management, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution. 5. Assists RHMs and Clinically Integrated Network Sr Leadership with the implementation and effective utilization of PSPD and Revenue Management Systems as well as Trinity Health best practices and project management to achieve strategic and operational revenue management goals. 6. 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. 7. Serves as a subject matter expert by providing managed care contracting guidance and problem/issue resolution to RHM and CIN executive leadership as well internal colleagues on matters impacting projects and day-to-day assignments. Works with RHM departments to ensure that all services generate accurate and timely charges. 8. 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. 9. Provides support in the design and implementation of models to accurately report net revenues in support of the overall financial systems outcomes. 10. 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 analytics tools. 11. 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. 12. Develops and implements strategies that incorporate business needs and requirements, industry trends and technology solutions which facilitates the achievement of strategic and financial objectives. 13. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

Responsibilities

Conducts complex language and financial analysis with major payers.
Deploys managed care contract strategy for hospitals, ancillaries, physician and other RHM services.
Implements legal, financial and business requirements and objectives thorough project management and negotiations.
Provides consulting services, expertise and project management skills in major contracting and problem-issue resolution to RHM executive and PSPD leadership to improve the revenue base of the RHM, accelerate cash flows, decrease bad debt, and improve accuracy of revenue reporting.
Leads activities in strategy development, project management, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution.
Assists RHMs and Clinically Integrated Network Sr Leadership with the implementation and effective utilization of PSPD and Revenue Management Systems as well as Trinity Health best practices and project management to achieve strategic and operational revenue management goals.
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.
Serves as a subject matter expert by providing managed care contracting guidance and problem/issue resolution to RHM and CIN executive leadership as well internal colleagues on matters impacting projects and day-to-day assignments.
Works with RHM departments to ensure that all services generate accurate and timely charges.
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 support in the design and implementation of models to accurately report net revenues in support of the overall financial systems outcomes.
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 analytics tools.
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.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.