Vice President Payor Strategy

Beth Israel Lahey Health•Wakefield, MA

15d•$225,000 - $280,000

About The Position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Beth Israel Lahey Health (BILH) is seeking a leader to work with BILH in structuring and negotiating managed care and value-based care contracts and to drive strategy for Beth Israel Lahey Health including Beth Israel Lahey Health Performance Network (BILHPN), behavioral health, ancillary services and continuing care companies. The Vice President of Payor Strategy is a key member of the BILH leadership team, responsible for conceptualizing, developing and executing commercial, Medicare, MassHealth, and direct to employer contracts that support the system’s business objectives and meet the goals of all stakeholders. This executive leads contract negotiations, payer market review and analysis, identifying and summarizing provider competitive intelligence, managing the legal and operational, and contract finance aspects of all system payer arrangements. The Vice President of Payor Strategy will oversee strategy development to enable payer alignment with system strategic goals and lead key payer negotiations that need to include value-based models as well as FFS models for referral business. The position will have significant revenue responsibilities and will require a detailed understanding of healthcare financing and delivery as well as the ability to think strategically and offer innovative solutions to complex challenges. The Vice President will report to the President Population Health & Managed Care of the BILH Performance Network.

Requirements

10+ years related work experience in managed care; payer and provider experience desirable
Experience with and understanding of health care reimbursement methods, health care payment reform both locally and nationally
Experience working with cross-functional teams in complex organizations
Experience hiring, training and managing small teams and matrixed staff
Successful experience managing population health, including clinical considerations
Proven ability to successfully build relationships with key stakeholders; CEOs and Executive Leadership team and leaders across the system
Ability to think on his/her feet and offer creative insights and constructive responses when faced with difficult concerns and issues raised by payers, executives and Board-level and management level stakeholders.
Proven success working under extreme pressure where consequences of error could result in material negative financial outcomes that have high impact on the organization or members of BILHPN. Errors in accuracy, judgment, tact, or communication could result in significant loss of credibility with Network stakeholders, payers or regulators. Individual must have a track record that demonstrates mastery of these characteristics within a complex, fast-moving environment.
Demonstrated ability to manage varied and competing interests of current stakeholders, other potential stakeholders, and future concerns in order to preserve the mission and long-term vision of a fast-growing, deadline-focused organization operating in a rapidly changing environment.
Advocates for the desired culture in high-level planning and decision making, with a focus on performance accountability and achieving greater operational efficiencies
Excellent staff leadership, operations development and oversight, program supervision and management skills of a diverse team ensuring that succession and development plans are in place to achieve the company’s goals.
10+ years related experience in a senior level position dealing with managed care strategies, contracting, finance, and operations support within a complex healthcare system, integrated delivery system, payer or other managed health care environment.

Responsibilities

Provide strategic thought leadership and partnership to all constituent entities of BILH and BILHPN.
Develop annual and multi-year payer strategic plans aligned with changing healthcare and reform landscape in the context of the BILH/BILHPN’s overall strategic direction and mission.
Oversee negotiations with payers on behalf of the enterprise to ensure the results meet enterprise goals.
Develop and evolve value-based contract models and negotiate terms with the payers.
Meet revenue and budget BILHPN and enterprise targets.
Lead the Managed Care Contracting, Contract Analytics and Medical Economics teams to be competitively reimbursed for the value BILH brings to the Commonwealth.
Partner with BILH Solutions to pursue and develop relationships with employers with regard to narrow network plan design, and new payment and relationship models.
Provide input to senior management relative to business development and strategic positioning as it relates to payer strategy.
Serve as a liaison to the payer community on payment issues after other escalation attempts have failed.
Be an effective partner to BILHPN and support its business objectives
Monitor relevant health plan and delivery system policy discussions at a state and national level to assess opportunities and threats related to emerging and evolving issues.
Integrate contracting, finance and analytic teams to support the payer strategy efforts.
Propose enhancements to operational processes to improve efficiency and/or effectiveness.
Ensure all departments develop processes, programs and metrics to achieve managed care contract service level agreements, quality standards, and performance goals.
Act as a key participant in the strategic and long-range planning of the organization.
Integrate long range plans with operational plans and capital priorities.
Lead discussions with Contract & Finance Committee of the Board regarding Managed Care contracts.