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Director, Valued Based Payer Contracting - Rush Health

Company: Rush Hospital
Location: Chicago
Posted on: February 17, 2020

Job Description:

Director Value Based Payer Contracting - Rush Health

Position Highlights:

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 procedures.

Position Responsibilities:

  • 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, Legal, Finance).
  • 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 relationships.
  • 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 finance staff.
  • 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 exchange requirements.
  • 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 warranted.
  • 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 MSSP, BPCI.
  • 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 process.
  • 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 departments.
  • 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 trends.
  • 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 payers.
  • 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 warranted.
  • 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 performance.
  • 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 innovation.
    • 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 direct-to-employer products.
    • Ability to think strategically.
    • Ability to think critically, understand complex concepts and quantitative analyses, synthesis information and make correct judgments.
    • 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 priorities.
    • Focuses on team success and promotes collaboration efforts with others.
    • 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.
      Company Highlights:
      • 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 age.
        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

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