The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits. Northern Light Health Department: Managed Care Contracting Position is located: Cianchette Professional Blding Work Type: Full Time Hours Per Week: 40.00 Work
No Hours Assigned Salary Range : $279,660.00-$340, 270.00 Exempt: Yes
The vice president of payer strategy & managed care operations oversees all aspects of payer contracting and relations with responsibility for the strategy, negotiation and execution of fee-for-service and value-based contracts for Northern Light Health (NLH) and all its subsidiary member organizations. The vice president is responsible for managing the contractual relationships between NLH’s business partners (e.g. employers) and payers to assure strategic alignment across the NLH Enterprise.
Reporting to NLH’s senior vice president (SVP) & chief financial officer (CFO) and partnering with NLH’s vice president & senior counsel on legal, strategic and relevant operational matters. The vice president collaborates with other key NLH stakeholders. These stakeholders include, but are not limited to the, SVP of strategy, SVPs of member organizations including Beacon Health, VPs of finance of member organizations, VP of finance, VP revenue cycle and the AVP of finance & analytics.
The vice president leads a team of contract managers and consultants that are responsible for negotiating and managing contracts with business partners and payers. The vice president of payer strategy & managed care operations is accountable for the overall financial and operational performance of NLH’s contracts with commercial payers such as Aetna, Anthem, Cigna and United Healthcare and other third-party contracts impacting gross to net patient service revenue amounts for member organizations including Beacon Health.
Contract performance with commercial payers relates to the financial yield that the contracts produce and to the administrative burden required to support these contracts. The vice president is similarly responsible for aligning both the tactical (near-term) and the strategic (long-term) objectives of NLH in each contract. Informing and influencing NLH senior leaders regarding emerging trends, obstacles and opportunities relative to industry and governmental developments related to payer/provider reimbursement methods and schemes is central to this function.
Supporting the professional development of the payer strategy & managed care operations team is another central function of the vice president. Creating a high-performance team of professional contract negotiators that work collaboratively to achieve NLH’s revenue objectives as the healthcare industry migrates for fee-for-service to value-based reimbursement is essential to NLH’s financial viability. Establishing a robust and effective relationship with the Revenue Cycle, Finance & Analytics and Information Technology Teams is vital to the overall success for this position.
Leads by example and manages a team of highly effective contract managers and contract consultants that are responsible for negotiating and supporting contracts with business partners and payers Collaborates with Revenue Cycle, Finance & Analytics, Beacon Health, member organizations and other departments to achieve financial and operational success for the NLH Enterprise Develop a payer strategy that supports the NLH near and long-term financial and operational goals Assist NLH’s effective transition to reference-based pricing methodologies Display data and models that illustrate how aligning with business partners and payers on access, cost, quality and patient satisfaction supports NLH objectives Partner with the vice president & senior counsel and Beacon Health to establish value-based contracts that delivers a sustainable and growing source of revenue to NLH Create and implement payer strategies that create a competitive payer landscape that ensures NLH enjoys a diverse payer profile over the long-term Fosters an environment that encourages professional development within the payer strategy & managed care operations team Other Information : Demonstrated ability to negotiate and manage payer / provider contracts that include payment methods including, discounted fee-for-service, referenced-based pricing or fixed pricing including but not limited to DRG/OOPs/RBRVS, etc. and value-based contracts including but not limited to P4P, gain / risk share and capitation Proven track record of building, leading and mentoring high performance teams that achieve established strategic objectives Proven ability to manage effectively in a highly complex, matrixed and political environment while helping the enterprise and its member organizations succeed Competencies and Skills Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct.
Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan. Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them.
Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit. Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible.
As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately. Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions.
Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others. Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner.
Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability . Education Required Master's Degree Working Conditions Need to drive to perform responsible duties.
Lifting, moving and loading less than 20 pounds. Prolonged periods of sitting. As an integrated health delivery system serving Maine, Northern Light Health is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state.
Our care team—in hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency care—are committed to making healthcare work for you: our patients, communities, and employees. Questions? Contact Talent Acquisition: phone: 207-973-7100 email: talentacquisition@northernlight.org Brewer, Maine, Corporate Office, Cianchette, Foundation, Finance, Human Resources, Legal Services