Vice President, Payor Strategy

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, and managing the legal, operational, and financial aspects of all system payer arrangements.

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 the changing healthcare and reform landscape in the context of BILH/BILHPN’s overall strategic direction and mission.
• Oversee negotiations with payers on behalf of the enterprise to ensure results meet enterprise goals.
• Develop and evolve value-based contract models and negotiate terms with payers.
• Meet revenue and budget targets for BILHPN and the enterprise.
• Lead the Managed Care Contracting, Contract Analytics, and Medical Economics teams to ensure competitive reimbursement for the value BILH brings to the Commonwealth.
• Partner with BILH Solutions to pursue and develop relationships with employers regarding narrow network plan design and new payment models.
• Provide input to senior management on business development and strategic positioning related to payer strategy.
• Serve as a liaison to the payer community on payment issues after other escalation attempts have failed.
• Support BILHPN’s business objectives and monitor relevant health plan and delivery system policy discussions at state and national levels.
• Integrate contracting, finance, and analytic teams to support payer strategy efforts.
• Propose enhancements to operational processes to improve efficiency and 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, integrating long-range plans with operational plans and capital priorities.
• Lead discussions with the Contract & Finance Committee of the Board regarding Managed Care contracts.

Requirements

• 10+ years of related work experience in managed care; payer and provider experience desirable.
• Experience with and understanding of healthcare reimbursement methods and healthcare 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.

Skills

• Proven ability to build relationships with key stakeholders, including CEOs, executive leadership, and system leaders.
• Ability to think creatively and offer constructive responses when faced with difficult concerns from payers, executives, and board-level stakeholders.
• Proven success working under extreme pressure where errors could result in material negative financial outcomes.
• Demonstrated ability to manage varied and competing interests of stakeholders while preserving the mission and long-term vision of the organization.
• Advocates for desired culture in high-level planning and decision-making, focusing on performance accountability and operational efficiencies.
• Excellent staff leadership, operations development, program supervision, and management skills for a diverse team.

Goals and Objectives

• Develop the payer contracting governance structure to support BILH entities and ensure stakeholder engagement and BILHPN.
• Develop a payer and employer strategy that incorporates innovative models for value-based care.
• Create a plan for transitioning contracts from entity-based to Beth Israel Lahey Health and BILHPN system-wide agreements.
• Develop the infrastructure needed to support these activities.
• Model leadership behaviors and drive system alignment.

Qualifications

10+ years of 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 healthcare environment.

Pay

Annual base salary range: $225,000.00 USD - $280,000.00 USD. In addition to base compensation, this position may be eligible for performance-based incentive bonuses.

Beth Israel Lahey Health requires all staff to be vaccinated against influenza (flu) as a condition of employment.