Vice President – Payer Strategy

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Vice President
– Payer Strategy Irvine , California Apply Now Providence Caregivers
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Providence is calling a VP of Payer Strategy to be located in our Southern California market, preferably Orange County.

THE ROLE

The Vice President, Payer Strategy is accountable for developing and advancing a coordinated approach for Providence St.

Joseph Health (PSJH) to develop expansion, new product and partnership strategies across the payer portfolio of over $18B (eighteen billion dollars) for Commercial, Exchange, Medicare Advantage and Medicaid product lines.

The Vice President, Payer Strategy works collaboratively in partnership with system and regional leadership to develop and advise PSJH on contracting partnership strategies and opportunities for growth/payer pull-through initiatives.

This leaders’ focus will be to work with payers to expand partnerships leveraging expanded capabilities that support our patients where they want to receive care to include telehealth and digital.

The Vice President, Payer Strategy serves as the lead working directly with the SVP Contracting, Chief Executives, Chief Financial Officers, Chief Strategy Officer, Business Development and Population Health Officers in the region.

This position reports directly to the SVP of Contracting with a matrix relationship to the designated leaders in the region and in Contracting.

The Vice President, Payer Contracting serves on a team that works together to design and implement strategies for growing the managed care portfolio through price and volume, expanding risk agreements and developing alternative payment methodologies to meet PSJH initiatives and goals.

The leader will work with stakeholders to leverage opportunities and resources with payers on behalf of PSJH.

This position will have a key leadership role and be responsible to build strategic growth partnerships between the payers and the providers within our system and those providers affiliated with PSJH.

The position will work closely with our various ACO structures, physician groups, regional healthcare systems, and management structures to achieve the financial goals and strategic priorities identified by the system on an annual basis.

ESSENTIAL FUNCTIONS

The VP Payer Strategy will:

In partnership with regional and system leadership, develop contracting growth strategies across all lines of the PSJH managed care portfolio.

Develop aligned relationships with Payers to seek new product growth opportunities.

Continuously collaborate both internally and externally to enhance the payer relationships.

This role demands a high degree of integrity to influence key stakeholders across the organization.

Develop and maintain strong relationships and partnerships with key payers to advance PSJH’s goal of managing the health of our population.

Develop aligned relationships with Regional leadership by facilitating and maintaining strong working relationships between contracting staff and the regional leaders.

Provide strategic thought leadership regarding value-based and contracting initiatives.

Develop a state-level strategy relative to business development and strategic positioning as it relates to payer strategy.

Work with key Regional leadership to define contracting strategies that further the mission, vision and values of PSJH.

Develop pricing methodologies in support of new program or clinical business planning (i.e.

bundles, centers of excellence, etc.)

Be responsible for developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability and value.

Capable of developing innovative risk sharing arrangements that increase opportunities for revenue growth and aligned incentives for appropriate management of the total cost of a population.

Develop market level contracting strategies and alignment with finance and other operational areas of the organization.

Work with our system leaders in Clinical Program and Services to expand access to our traditional service areas, Centers of Excellence, and community support service.

Work with payer and contracting leadership to develop contracts that expand beyond our traditional service areas for Centers of Excellence and bundles.

In partnership with the regional contracting market and analytics directs the evaluation of new payment models.

Advise the market, finance and system leaders on emerging trends and methodologies in managed care contracting and payer relations.

Ensure timely renewals of agreements and that all agreements are implemented effectively to optimize effectiveness.

Act promptly on management questions and requests from key stakeholders.

Educate regional leaders on emerging payment models and collaborates with appropriate system leadership on the development of new payment models.

Report on payer performance and emerging models of care to senior management along with recommended course of action.

Work with leadership to understand key initiatives and to ensure contracts are aligned with PSJH’s strategic goals.

Responsibly recommend and participate in the development of new services and programs and serves as a thought leader with the Provider contracting team on issues related to network development and value creation for the region.

Will be responsible to develop a portfolio contracting strategy that will support the growth of the organization with a focus on value based care.

Participate at a senior level on committees, work groups or with associations aimed at advancing the work of Payer Contracting.

Represent PSJH as a leader in health care industry association(s) and organization(s).

Participate in administrative staff meetings and attends other meetings as assigned.

Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

Work with the Government Programs and Population Health Informatics team on the implications of payment reform and health care reform at the federal, state, and local level.

Qualifications:

QUALIFICATIONS

Required experience/education for this position include:

Bachelor’s Degree preferably in healthcare administration, finance, business, or related filed

Minimum 15 to 20 years’ experience in development of contracting strategy at a health system or health plan

Minimum of 15 to 20 years In leadership position-management of field based teams

Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives, preferably for an integrated health care delivery system or managed care company

Minimum of 10 years with increased contracting responsibility for a portfolio that covers >$5b in managed services

A thorough understanding of the financial arrangements of the hospital, health plan, and medical group in a capitated and non-capitated environments is required

Deep understanding of both fee-for-service and at-risk payer contracts.

Current knowledge of the changing health care landscape at the national and state level.

Strong working knowledge of health care contract language and negotiation strategies.

Thorough knowledge of laws and regulations relating to managed care and other payer functions

Ability to develop strong, trusting external relationships with payers.

Ability to gain confidence and trust of leadership across the organization

Creative, innovative thinker bringing new ideas and solutions to internal strategy discussions and contract negotiations.

Ability to work collaboratively and credibly across senior leadership both at the system and regional levels.

Preferred experience/education for this position include:

Master’s Degree in Business Administration (MBA), Health Administration (MHA); or equivalent education/experience

Contracting experience across a portfolio of products that include government programs e.g.

Medicare Advantage, Medicaid and other Government programs preferred

Experience negotiating facility, professional, and continuum contracts for commercial, Medicare Advantage in a fee-for-service and alternative payment models to include Capitated preferred.

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About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable.

Providence is proud to be an Equal Opportunity Employer.

Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual