Director Payor Contracting McLaren Physician Partners

Essential Functions and Responsibilities

• Executes contracting activities with Third Party Payors as assigned.
• Collaborates on strategic planning of contracting activities.
• Resource for all contracting activities of MPP, MHCC and its subsidiaries, including providing ad hoc assistance and support as requested.
• Reviews, redlines, and evaluates the language of Managed Care contracts.
• Participates and leads negotiations, and identifies any issues and coordinates contract workflow/approval through to contract execution.
• Develops and implements policies and procedures to monitor contractual obligations and ensure compliance with such (i.e. annual performance benchmarks, payment rate changes, etc.).
• Analyzes changes in legislation, payer policies, rules and regulations impacting both facility and physician payments, including but not limited to monitoring industry developments.
• Communicates and educates those impacted, as necessary.
• Defines priorities and communicates to staff departmental goals and works with them to achieve them; seeks commitment from staff, encourages innovation and motivates through team building/planning.
• Acts as liaison between contracted Health Plans and MPP, MHCC, MHPN and subsidiaries, including but not limited to, research operational issues and review of payor policies needed to resolve issues.

Requirements

• Bachelor’s degree in business, health care or related field.
• Ten (10) years’ experience in complex provider contracting and servicing in a managed care organization, Health System, Health Plan, PHO, PO or similar organization, including three (3) years in a management role with direct reports, leading or in all phases of effective supervision (i.e. Recruitment, performance management, training).

Preferred

• Master’s degree in health care management, Finance or related field.
• Experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments.