Director of Payor Relations

Qualifications and Experience

• Seven (7) years of progressive leadership experience in large healthcare organizations, payor organizations, and/or integrated healthcare delivery systems
• Seven (7) years of experience in strategic management of healthcare pricing, contract negotiation, and healthcare economics in a complex, multi-regional healthcare practice/system or health insurance environment
• Demonstrated track record of leading complex contract negotiations in support of fee-for-service, value-based, and alternative payment model strategies
• Demonstrated success in leading, implementing, and managing financial performance of payor contracts
• Demonstrated ability to work effectively and to have effectively driven strategic transformation work
• Bachelor's degree in Business Administration or related clinical field. Master’s prepared with an MBA or MHA strongly preferred

Responsibilities

• Responsible for strategic and operational integration activities of managed care payor strategy across EmergeOrtho, to include oversight of, and collaboration with, the following managed care functions: payor strategy, value-based contracting strategy, contract management and operations, and commercial bundles
• Implement and monitor success of payor strategies to drive sustainable financial performance
• Develop and maintain enterprise value-based contracting strategies and implementation guardrails that lower total cost of care, improve population health and drive growth & sustainable financial performance
• Oversee managed care contract maintenance, access, and operational management processes and activities
• Monitor, analyze, and provide strategic insights on CMS reimbursement & payment policy changes impacting managed care contracts & payor strategies
• Lead and deliver research, analysis, and payor strategy development activities to support successful strategy execution and merger/acquisition/divestiture transactions
• Demonstrate concrete and relevant revenue linkages between payor contracts, value generation to customers, and objectives
• Lead and advocate for new innovative products, develop business rationale for Medicare Advantage, and other appropriate opportunities
• Maintain professional affiliations and enhance professional development to keep current in the latest health care trends and developments
• Prepare agendas, reports, and presentations for committee, board and shareholder meetings; lead discussions and coordinate any subsequent changes
• Write and respond to a high volume of emails in a prompt manner; place and retrieve many phone calls daily