Director, Valued Based Payer Contracting - Rush Health
Company: Rush Hospital
Posted on: February 17, 2020
Director Value Based Payer Contracting - Rush Health
The Director Value Based Payer Contracting has responsibility for
negotiating and managing value based care (VBC) contracts on behalf
of Rush Health Participating Physician practices' and Participating
Hospitals' (Members) with third party payers, including but not
limited to Commercial payers, Medicare Advantage payers and
Medicaid managed care payers. This position shall also coordinate
and manage any VBC contract terms with governmental payers
including CMS. Responsibility includes management of all VBC
arrangements including Rush Health's Clinical Integration Program
(CIP) with third party payers, Pay-for-Performance agreements and
risk based agreements including ACO, shared savings/shared risk,
capitation, global bundled pricing and % of premium contracts. In
coordination with the Director FFS Payer Contracting, this position
is responsible for managing and facilitating the relationships with
third party payers including Joint Operating Committees (JOCs).
This position shall also assist in Member education and internal
program management of VBC agreements. This position is pivotal to
capturing and retaining business for our Members and growing and
maximizing financial performance. Exemplifies the Rush mission,
vision and values and acts in accordance with Rush policies and
- Negotiate and manage all value based care (VBC) contracts with
third party payers in consultation with Rush Health business and
support departments (Clinical, Analytics, HIT, Payer Relations,
- Supervise and manage Payer Contracting Managers in conjunction
with the Director FFS Payer Contracting.
- Working jointly with the Director FFS Payer Contracting,
maintain and manage high level third party payer relationships and
coordination of all payer specific contract negotiations.
- Build and maintain positive ongoing relationships with all
third party payers with the objective of maximizing market share
and revenues for Members.
- Partner with VP Payer Contracting, Director FFS Payer
Contracting and senior leadership to devise payer strategies that
align with organizational goals including market access and
financial strength. This includes evaluation and initiation of new
VBC contract opportunities, business models and payers
- Advance organization's value based payment strategy through
optimization of existing contracts and development of new risk
based reimbursement models and innovation VBC programs.
- Negotiate VBC financial risk terms working in conjunction with
Analytics and actuary, when needed, to develop financial risk
models to analyze payer VBC proposals including ACO, shared
savings/shared risk, capitation, global bundled pricing and % of
premium contracts. Assess risk exposure, potential upside and
downside opportunities and coordinate feedback from Member CFOs and
- Partner with CMO and clinical leaders to develop and evaluate
quality based metrics and VBC contract incentives.
- Coordinate feedback and approval of VBC contracts including VBC
financial risks and rewards from Rush Health governing bodies.
- Negotiate VBC contract language and performance terms in
consultation with Rush Health business and support departments
(Clinical, Analytics, HIT, Payer Relations, Legal, Finance). This
includes legal, compliance, quality measures, reporting and data
- Coordination through VBC Workgroup.
- Facilitate internal VBC Workgroup that shall monitor, analyze
and manage VBC contract performance, requirements and
reconciliation. Coordinate work product in coordination with Rush
Health business and support departments (Clinical, Analytics, HIT,
Payer Relations, Legal, Finance). Initiate renegotiates as
- Monitor, track and communicate VBC market intelligence and
trends including local and national commercial and governmental
payer VBC innovations and initiatives and assist in development of
annual VBC strategic plan under the direction of the VP, Payer
Contracting and Rush Health senior leadership.
- Coordinate and manage VBC program initiatives and contract
terms with governmental payers including CMS and programs such as
- In collaboration with the Rush Health CMO, negotiate and manage
the CIP/P4P quality and efficiency terms in third party payer
contracts both Rush Health CIP programs and Payer specific
programs. Coordinate the annual payer incentive reconciliation
- Lead implementation and coordination of new VBC contracts
including governance, communication, education, business
operations, HIT, care delivery, analytics and reporting in
collaboration with Rush Health business and support
- Establish, facilitate and participate in Payer VBC joint
operating committee (JOC) meetings.
- Work closely with Rush Health business and support departments
(Clinical, Analytics, HIT, Payer Relations, Legal, Finance) to
develop, communicate and disseminate orientation and educational
materials to inform and educate Members regarding VBC contract and
performance terms, reporting tools and resources and market
- Develop and maintain VBC contract summaries including
performance targets and measures matrix, timelines, contract
requirements and deadlines.
- Serve as the liaison for Rush Health business and support
departments to initiate and manage VBC communications including
questions and operational requirements with third party
- In coordination with Payer Relations and the Payer Contracting
Managers, monitor and manage VBC payer compliance issues including
rosters, assignment, reports, delivery dates, fees, audits.
- Monitor and analyze changes in payer VBC programs and policies
that may affect contract performance and initiate negotiations as
- Working with Payer Contracting Managers, coordinate any
credentialing or request for information (RFI's) requirements for
new VBC initiatives.
- Participate in and report to various governing bodies including
the Rush Health Finance and Audit committee and any VBC committees;
provide support for these meetings and assist with VBC contract
material preparation and presentation.
- Create strategic alliances with internal and external groups to
maximize Member and payer relations and VBC contract
- Staff Committees as assigned.
- Other duties and responsibilities as assigned.
Position Qualifications Include:
- Master's degree in Health Care Administration or Business.
- 10 years' experience in a managed care environment with direct
payer contract negotiation experience in a multi-facility health
system, large academic medical center or insurer environment.
- Strong industry knowledge of population health management
activities, value based care delivery models and payment
- Direct experience leading the negotiations and management of
complex VBC risk contracts.
- Strong financial knowledge base related to all managed care
reimbursement methodologies including the various fee-for-service
structures and risk based structures such as capitation, shared
savings and global payments.---
- Specific experience and strong track record in developing and
executing innovative payer VBC strategies.
- Management experience.
- Experience working with consultants, brokers, employers and
- Ability to think strategically.
- Ability to think critically, understand complex concepts and
quantitative analyses, synthesis information and make correct
- Ability to communicate clearly and persuasively.
- Strong written and verbal communication skills.
- Strong analytical and financial skills.
- Strong attention to detail and well organized.
- Adapts well to rapid change and multiple, demanding
- Focuses on team success and promotes collaboration efforts with
- Excellent time and project management skills.
- Ability to network internally and externally to build
relationships, facilitate discussion and resolution.
- Microsoft Office Suite advanced proficiency, particularly MS
Excel and PowerPoint.
- Experience with governmental programs related to Medicare,
Medicaid and Medicare Advantage highly desirable.
- Rush University is known for its high-quality health care
education, supportive learning environment, engagement with the
urban community and forward-looking education approach.
- Rush University is a health science university that is integral
to Rush, an academic health system that includes three hospitals
and numerous outpatient care facilities.
- Rush University is ranked 22nd on the Times Higher Education's
2016 list of the world's top 150 universities under 50 years of
Rush is an equal opportunity employer. We evaluate qualified
applicants without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, disability, veteran
status, and other legally protected characteristics.
Keywords: Rush Hospital, Chicago , Director, Valued Based Payer Contracting - Rush Health, Accounting, Auditing , Chicago, Illinois
Didn't find what you're looking for? Search again!