SCOPE OF ROLE

The Director, Payor Contracting will be responsible for driving the contracting strategy and building health plan relationships for the NeueHealth Value Service Organization (VSO) , VSO clients, and owned practices. This role will directly support VSO clients and owned practices in identifying and prioritizing payor relationships, assessing risk profiles, and negotiating optimal risk-based contracts with health plans, including contract review, negotiation of terms, and strategic positioning. The Director will be responsible for the maintenance of managed care plan operating policies and systems, coordinating the analysis, reporting and negotiation of payer contracts, and working collaboratively with VSO clients and owned practices to ensure alignment. Given the VSO’s growth trajectory, contracting activities will accelerate substantially in volume, financial impact, and complexity so this role is ideal for a candidate who thrives in a fast-paced environment.

ROLE RESPONSIBILITIES

• Develop payer contracting strategy and facilitates the negotiation of contract terms and rates with health plans and payers, including on behalf of VSO clients and owned practices
• Establish innovative relationships with national and local health plans to create a competitive advantage in the market
• Work cross functionally to assess and respond to payment proposals and to develop modeling analysis tools
• Lead the negotiation and monitoring of contract performance of value-based contracts with payers, including the success of meeting financial and quality targets
• Support VSO clients, owned practices, and local network teams in all aspects of payor contracting; includes continued development and dissemination of systems, processes and best practices for local teams
• Keep client and practice informed throughout negotiations to ensure their alignment and documentation of business decisions around the negotiation
• Prepare contracting recommendations for client boards to approved
• Monitor, analyze and report on the state of the payer industry via report cards and other assessments

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree required; MBA, MHA, or similar degree preferred
• A minimum of 10 years of related experience in health care administration
• Five (5) or more years experience in payor and/or provider contracting
• Demonstrable network of broad, deep, and relevant relationships with health plan leaders and/or track-record of developing such relationships
• Deep understanding of Medicare reimbursement, Medicare Advantage health plan economics, and value-based and capitation contracting models, including legal and regulatory considerations
• Proven ability to negotiate risk-based and capitated contracts with health plans and affiliate or downstream contracts with providers
• Demonstrated success negotiating value based contracts with various health plans using a diverse range of techniques and contracting ''best practices'' to include capitation, quality reward programs, and path-to-risk arrangements

PROFESSIONAL COMPETENCIES

• Strong collaboration skills with a broad group of internal and external stakeholders and business partners
• Excellent written and verbal communication skills
• Ability to thrive in a fast-paced environment
• Ability to work under pressure with minimal supervision, multi-task, complete projects in a timely fashion and meet deadlines
• Excellent analytical, problem solving and organizational skills a must
• Experience working in highly matrixed and cross-functional environments
• Advanced Excel, PowerPoint skills

SUPERVISORY RESPONSIBILITIES

• This role will have direct reports.