System Director Payer Strategy

CommonSpirit Health•Englewood, CO

2d•Remote

About The Position

CommonSpirit Health is a large, faith-based integrated health system dedicated to improving health for all. As a System Director, Payer Strategy, you will be instrumental in shaping managed care objectives, focusing on contract terms, reimbursement, negotiation, and cultivating key payer relationships. This remote position requires deep expertise in the Payer or Provider landscape, with a strong preference for candidates located west of the Mississippi. You will negotiate various contract types across the organization's geographies and business lines, gathering and disseminating strategic insights to internal teams. Your role is critical to the organization's financial health and long-term strategic direction, ensuring favorable reimbursement and protecting the interests of associated entities. Success hinges on strategic negotiation, understanding payer dynamics, and effectively communicating complex information to diverse stakeholders to foster optimal outcomes and strengthen partnerships.

Requirements

Bachelors Other or equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree.
Minimum of seven (7) years’ progressive leadership experience in the healthcare environment, of which five (5) years are in managed care contracting for a hospital, healthcare system, or health plans in an intensive managed care market.

Nice To Haves

Extensive knowledge of the Payer or Provider landscape in xxx.
Strong preference for the candidate to live west of the Mississippi.

Responsibilities

Leads in the development of National Payer strategy, relationships, and contracts with assigned National Payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation in order to achieve the budgeted and forecasted performance and growth requirements as set forth by national and divisional senior leaders.
Gathers information and drafts negotiation goal alignment with Division senior ministry leaders relative to the strategic, operational, and financial needs and expectations of each Division impacted by the National Payer.
Establishes, builds, and maintains positive, strategic interactions and relationships with assigned National Payer(s), employers, providers, and leaders across the ministry.
Documents ‘Lessons Learned’ session following each renewal with their assigned National Payer with the PSR and PAE teams involved in the negotiations to document successes as well as opportunities for improvement for future renewals.
Engages consistently in effective communication with internal stakeholders across the ministry to ensure key contract terms and requirements are successfully implemented to ensure optimal contract performance and revenue expectations.
Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
Works intimately with internal analytics teams.
Analyzes and monitors financial aspects of existing managed care contracts and rate structure opportunities.
Gathers feedback from ministry leaders on financial, revenue cycle, and operational issues with the National Payer related to contract renewals, renegotiations, payer compliance, or termination scenarios, and leverages this feedback to make recommendations regarding participation or non-participation with new or existing agreements and networks.
Makes independent decisions and/or exercises sound judgment based upon appropriate information and objectives.
Comprehends and maintains highly detailed information.
Accepts and carries out responsibility for direction, control, and planning.