Sr. Director, Payer Strategy & Relations

Join a Legacy of Care - Celebrating 50 years of Healing and Hope

For over five decades Cancer Care Northwest has been the Inland Northwest's premier cancer center, providing an integrated approach to the diagnosis, treatment and healing of cancer and blood-related diseases.

Our collective passion to fight against cancer is what motivates and inspires us every day and is the reason Cancer Care Northwest has become the Inland Northwest's premier cancer center. We provide comprehensive, innovative, compassionate, integrated care throughout each patient's journey. We are searching for dedicated professionals who share our passion in saving lives. Are you looking to work alongside a team of professionals passionate for patient care? Join us in our mission to save lives.

Strategic: Leads all strategic development of third party payer strategies. Directs the formulation and execution of all managed care initiatives and strategies that will maximize opportunities with third party payers and provider partners including hospitals and PCP networks and employees statewide. Oversees managed care related policies, procedures and processes in support of strategic objectives.

Develops and executes in conjunction with members of the US Oncology Network support staff on practice strategic planning and both long and short term goals to position the practice optimally within the third party payer environment and local hospital/provider market. Prepares forecasts and advises senior management within the US Oncology Network and practice leadership on all matters concerning net revenues in the areas of Commercial Managed Care, Medicaid and Medicare. Develops and maintains payer relationships and advocates for the community-based oncology agenda with payers locally, identifying opportunities for enhanced relationships, reimbursement, referrals and a growing market presence. Overall, responsible for directing all contract negotiations and strategies.

Operational: Directs key staff on payer recoupment, credentialing and operational projects to ensure timely payment of large transactions and initiatives to improve payer-related revenue cycle operations. Responsible for ensuring all fee schedules are appropriately loaded into Centricity and payments are accurately based on negotiated fee schedules. Leads all strategies and negotiations to support alternative payment models with a focus on including novel payment models such as value-based reimbursement methodologies (i.e., case rate development, integrated networks, contract capitation, total cost of care initiatives and shared savings models) and has a firm grasp on the analytics/practice impacts that support such payment models. Serves as "expert" adviser to management team regarding maximizing revenue from managed care products and Medicare and Medicaid programs. Develops and makes recommendations regarding changes needed to enhance and optimize physician income and overall practice revenues.

Program Outcomes: Directs and oversees alternative payment models to ensure delivery of compelling results to ensure gain share and quality measures are optimized. This includes oversight of practice reporting, outcomes measures, etc. developed and used in support of such practice initiatives. Includes leadership and a focus to support risk-based contracts, claims studies, actuarial evaluations and episodic payments where gain share (or upside), steerage and other upside to the practice are included. Organizational Responsibilities: Creates a shared vision and demonstrates the ability to clearly articulate the organization's desired position, creates a common goal for unity among groups with diverse interests and beliefs, clearly communicates the organization's mission, strategies, goals and priorities, defines team members' roles and responsibilities, seeks input and buy-in from team members and establishes alignment throughout the organization. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. Combines judgment, extensive experience and business and industry knowledge to make sound decisions.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Plans, develops, directs, coordinates and monitors all managed care activities to successfully bring to market new products, methodologies, and strategies and to negotiate compelling contracts with both payers and providers (where appropriate). Works with McKesson operations, finance, managed care team, and the pharmacy team, directs and advises on strategies and solutions, and sets benchmarks to ensure that contracts negotiated in accordance with budgeted objectives to obtain maximum profitability and volume in relation to pre-set standards and specific trends within the industry. Sets annual managed care and value based budget Evaluates practice trends and variances to plan and provides information to senior management and field. Communicates and educates all internal customers as to the prudent and most effective manner with which to deal with payers and situations. Develops and recommends payer pricing, contracting and operational strategies to optimize the long-term financial profitability of the practices and the company. Evaluates opportunities to take financial risk and looks proactively to ensure a longer term, compelling strategy to ensure a growing referral base, market differentiation and practice growth. In coordination with the revenue cycle leadership, evaluates, sources, designs, recommends and monitors the execution and effectiveness of policy, procedure and processes designed to ensure timely and accurate reimbursement of payers. Ensures adherence to legal requirements and government reporting regulations affecting payers and how it impacts the Practice. Takes responsibility for and coordinates the execution of all aspects of the practice's tactical and strategic payer initiatives including responsibility for creating and maintaining positive external relationships with all relevant payers, providers and employers, where relevant. Directs the development and implementation of short-term and long-range plans and budgets based upon the managed care goals and objectives and reports all outcomes accordingly. Oversees legal and regulatory environment as well as serves as an "expert " resource related to legal and business review of all managed care contract documents, amendments, and correspondence. Manages, coaches and develops Managed Care staff. Responsible for interviewing, recommending hires, assessing performance, recommending salary changes, and progressive discipline. Enforces adherence to USON policies.

OTHER KEY RESPONSIBILITIES: Coordinate activities, exchanges information and clarifies needs from a Managed Care perspective with Marketing, Business Development, Finance, revenue cycle management, pharmacy operations and the clinical team. Serves as the Managed Care liaison/advocate for new practices that are added to the practice. Works with and coordinates local managed care initiatives with The US Oncology managed care support staff Monitors markets, industries, and companies to maintain and updated information base by participating in industry organizations including developing new contracts, knowledge and trends to cultivate new strategies.

MINIMUM QUALIFICATIONS: Excellence in academic training at all levels. Master's degree required in Finance, Business, or Healthcare Administration Minimum of fifteen years healthcare management experience in a managed care environment including significant experience in commercial payer strategies, pricing, reimbursement and healthcare costing analysis. Supplemental experience in strategy consulting in healthcare related fields or serving healthcare clients may be relevant. Comprehensive knowledge of healthcare planning, finance, marketing, reimbursement, and related activities.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment or may be remote and requires significant interaction with managed care regional team as well as local managed care resources and Practice leadership teams... and externally with clients and customers. Work will require local by automobile and attendance at national US Oncology meetings, as needed.

Annual Salary Range: $137k - $210k - $284k

Target Bonus: 15%

Benefit information: Benefits