(REMOTE) Sr. Managed Care Contracting Consultant
Trinity Health

Livonia, Michigan

Posted in Medical and Nursing


This job has expired.

Job Info


Employment Type:
Full time
Shift:

Description:

* Position allows for work remote opportunity.

* Hourly pay rate: $54.86 - $90.51

POSITION PURPOSE

Provides managerial direction, leadership, consultation project management and specialized expertise in the delivery of large, complex and highly visible major payer contracting project initiatives and negotiations for Trinity Health at a System level for national payer contracts or at a regional market level for regional payers. Additionally, provides managerial direction, leadership, consultation, project management and expertise for problem-issue resolution for major national or regional Managed Care payers. Provides strategic leadership in negotiating arrangements with HMO, PPO and other major payer contracting entities in the areas of price negotiations, settlements project management and evaluation of financial performance, among others.

Leads activities in strategy development, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution. Executes managed care strategies developed jointly with Regional Health Ministries (RHM) and System Office leadership. Work assignments involve significant project management, critical relationship, collaborative and consensus building skills while managing relationships between payers, providers and its shared services customers. Work assignments and responsibility require in-depth knowledge of managed care contracting and payer-provider relationships. Serves as a subject matter expert by providing contracting guidance and problem/issue resolution to internal colleagues on matters impacting projects and day-to-day assignments. Some travel is required.

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates, and demonstrates the mission, vision, and values of Trinity Health in leadership behaviors, practices, and decisions.

2. Conducts complex language and financial analysis with major payers. Deploys managed care contract strategy for hospitals, ancillaries, physician and other RHM services. Implements legal, financial and business requirements and objectives thorough project management and negotiations.

3. Provides consulting services, expertise and project management skills in major contracting and problem-issue resolution to RHM executive and PSPD leadership to improve the revenue base of the RHM, accelerate cash flows, decrease bad debt, and improve accuracy of revenue reporting.

4. Leads activities in strategy development, project management, contract negotiations, payer collaboration, pay for performance, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution.

5. Assists RHMs and Clinically Integrated Network Sr Leadership with the implementation and effective utilization of PSPD and Revenue Management Systems as well as Trinity Health best practices and project management to achieve strategic and operational revenue management goals.

6. Manages executive relationships to ensure active and focused engagement throughout initiatives. Participates in senior level forums and facilitates meetings and work groups to develop strategies, establish standards and resolve issues. Collaborates with leadership and key stakeholders to influence outcomes, remove barriers and resolve issues. May represent executive leader in various meetings. Apprises executive leaders and other key stakeholders of meeting content and outcomes. Serves as an escalation point for System Office and RHM concerns.

7. Serves as a subject matter expert by providing managed care contracting guidance and problem/issue resolution to RHM and CIN executive leadership as well internal colleagues on matters impacting projects and day-to-day assignments. Works with RHM departments to ensure that all services generate accurate and timely charges.

8. Serves as a seasoned, knowledgeable resource providing an extensive understanding of strategic issues and tactical initiatives and ensuring processes, workforce, technology and culture factors are addressed in enterprise, RHM, and System Office plans. Develops recommendations that provide practical options and tactical solutions while considering the impact on processes, workforce, technology and culture.

9. Provides support in the design and implementation of models to accurately report net revenues in support of the overall financial systems outcomes.

10. Directs the processes and guidelines around the configuration and maintenance of applicable Analytic Platforms. Develops reporting tools and dashboards for executive management using these systems and analytics tools.

11. Establishes and maintains on-going effective relationships and communication to customers, senior leadership, managers, stakeholders, staff and partner/vendor organization related to projects, new opportunities, and standardization opportunities. Facilitates a coordinated communication plan for internal and external audiences in order to foster a greater understanding of the benefits and value of the System objectives as well as other accomplished initiatives.

12. Develops and implements strategies that incorporate business needs and requirements, industry trends and technology solutions which facilitates the achievement of strategic and financial objectives.

13. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

1. Bachelor's degree in Business Administration, Finance, Accounting, Informatics or related field or an equivalent combination of education and related experience. Master's or Doctoral degree preferred. Extensive revenue management knowledge and experience. Requires a breadth and mastery of technical and business knowledge in multiple disciplines/processes.

2. Seven (7) to ten (10) years of progressively responsible operational (management), project management, consulting or relevant professional experience in revenue management (e.g., reimbursement, payer contracting, decision support, health information management, patient financial services).

3. Significant industry experience and expertise in Managed Care gained from health plan, health system, the healthcare industry or a provider health network is required. This position must be filled with succession planning as a key qualifying consideration. Must be able to step into the role of Regional Director as necessary to provide overall leadership for RHM and Statewide Managed Care responsibilities.

4. Ability to manage multiple large multi-functional/interdisciplinary and highly visible projects having a system-wide scope of responsibility and impact. Demonstrated increases in operational management or project management leadership experience.

5. Excellent leadership, analytical, organization, integration and executive skills and abilities. Extensive experience in planning, formulating and executing strategies, as well as the ability to define program, process or business objectives and scope. Demonstrated proficiency and expertise to identify, evaluate and articulate operational opportunities, business needs and gaps, plan and implement steps, understand stakeholder interest and provide authoritative consultation.

6. Excellent interpersonal, consultative, relationship and consensus building skills in order to effectively lead and facilitate multi-functional teams. Proven ability to initiate and develop collaborative partnerships with executive leaders, key stakeholders and decision makers. Ability to drive positive results in difficult situations and effectively respond to multiple, ever-changing and competing priorities. Formidable facilitation skills to lead and influence diverse member interests, teams and groups through strong leadership, communication, collaboration, negotiation and intuitive abilities. Ability to shape results, garner support and successfully manage complex relationships and influences within and across the organization.

7. Excellent planning, evaluative, organizing and problem solving skills in order to integrate activities that are relatively homogenous or diverse in nature.

8. Ability to influence results, garner support and tactfully manage complex relationships. Ability to read the subtle nuances of situations and react/plan accordingly.

9. Demonstrates superior oral and written communication, negotiation and presentation skills. Ability to facilitate communications between diverse groups. Ability to effectively identify, assess and facilitate improvements and solutions and present advisory and persuasive recommendations.

10. Considerable knowledge and experience supporting and developing reporting and analytics for research, process improvement/change management support and specific revenue management function. Ability to develop appropriate methods to collect, assimilate and analyze data.

11. Must possess deep analytical, quantitative, evaluative and problem solving skills.

12. Strong attention to detail and organizational skills. Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.

13. Ability to work independently and with minimal supervision. Ability to work in a team environment providing support to multiple positions.

14. Demonstrated ability to respect confidential and sensitive information, understanding and honoring lines of accountability and communication is essential.

15. Ability to operate in an ambiguous and matrix organizational structure. Ability to operate in a highly autonomous self-directed manner and to effectively respond to multiple, ever changing competing priorities.

16. Must be comfortable operating in a collaborative, shared leadership environment.

17. Must possess a personal presence that is characterized by a sense of honesty,

Integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

1. Must be able to set and organize own work: priorities, and adapt to them as they change frequently.

2. Must be able to travel to the various Trinity Health sites as needed.

3. Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.


This job has expired.

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