System Director Payer Strategy

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

This is a remote position that requires knowledge of the Payer or Provider landscape in the state of California. 

As our System Director, Payer Strategy, you will play a key role in assisting with planning, directing, and implementing managed care objectives related to contract terms, reimbursement, negotiation, and key payer relationship management. This position will focus on significant payer relationships, for which you will negotiate various contract types across the organization's geographies and business lines.

Every day, you will gather and disseminate insight and strategic knowledge to and from relevant teams and departments across the enterprise. This position is essential to the organization's financial performance, having significant impact on its long-term strategic trajectory. High expectations exist to secure favorable reimbursement, protect the interests of associated entities in contract negotiations, and strengthen relationships with significant payers.

To be successful in your role, you will strategically guide critical payer negotiations and relationship management, directly impacting the organization's financial health and long-term strategic direction. You will demonstrate expertise in contract dynamics, an understanding of payer landscapes, and the ability to effectively communicate complex insights to diverse stakeholders, ensuring optimal outcomes and strengthening vital partnerships for sustained success.

• Leads in the development of National Payer strategy, relationships, and contracts with assigned National Payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation in order to achieve the budgeted and forecasted performance and growth requirements as set forth by national and divisional senior leaders.
• Gathers information and drafts negotiation goal alignment with Division senior ministry leaders relative to the strategic, operational, and financial needs and expectations of each Division impacted by the National Payer. Establishes, builds, and maintains positive, strategic interactions and relationships with assigned National Payer(s), employers, providers, and leaders across the ministry.
• Documents ‘Lessons Learned’ session following each renewal with their assigned National Payer with the PSR and PAE teams involved in the negotiations to document successes as well as opportunities for improvement for future renewals.
• Engages consistently in effective communication with internal stakeholders across the ministry to ensure key contract terms and requirements are successfully implemented to ensure optimal contract performance and revenue expectations. Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
• Works intimately with internal analytics teams. Analyzes and monitors financial aspects of existing managed care contracts and rate structure opportunities. Gathers feedback from ministry leaders on financial, revenue cycle, and operational issues with the National Payer related to contract renewals, renegotiations, payer compliance, or termination scenarios, and leverages this feedback to make recommendations regarding participation or non-participation with new or existing agreements and networks.
• Makes independent decisions and/or exercises sound judgment based upon appropriate information and objectives. Comprehends and maintains highly detailed information. Accepts and carries out responsibility for direction, control, and planning.

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Required

• Bachelors Other or equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree.
• Minimum of seven (7) years’ progressive leadership experience in the healthcare environment, of which five (5) years are in managed care contracting for a hospital, healthcare system, or health plans in an intensive managed care market