REMOTE Sr. Managed Care Contracting Consultant

Employment Type:

Full time

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.

• 1. Bachelor’s degree in Public Health, Business Administration, Finance, Accounting, Economics, Informatics or related field. Master’s or Doctoral degree preferred. Requires a breadth and mastery of analytic and business knowledge in multiple disciplines/processes.
• 2. Seven (7) to ten (10) years of progressively responsible operational (management), project management or consulting experience in managed care analytics, medical economics reporting, product development or population health analytics or an equivalent combination of education and work experience. Previous managerial experience preferred.
• 3. Significant experience and proven results regarding complex project management or consulting experience in managed care analytics, medical economics reporting, and product development or population health analytics.
• 4. Significant experience gained from health plan, health system, the healthcare industry or a provider health network is required.
• 5. Demonstrated ability to lead and manage with frequent changes in departmental priorities.
• 6. Proven track record of effectively managing progressively large complex projects, which include the management of vendor relationships and multiple technology and analytic solutions to achieve a single business objective with proven successful delivery results.
• 7. Excellent program leadership, organization, integration and execution 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.
• 8. Proven customer-service orientation. Ability to know and understand customer requirements and exercise judgment in meeting reasonable expectations, particularly when differences of opinion on needs and services, unanticipated contingencies or divergent ideas and perspectives exist.
• 9. Strong interpersonal and relationship building skills with proven ability to initiate and develop productive collaborative partnerships with executive leaders, management, associates, and customers, along with effective vendor interface/management experience. 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.
• 10. Excellent oral and written communication, negotiation and presentation skills. Ability to translate and present technical information to clinical and operations staff (and vice versa). Ability to facilitate communication between diverse groups and interests, to effectively identify, assess and advance improvements and resolutions, and to provide advisory, consultative and authoritative recommendations to all levels of the organization.
• 11. Working knowledge of project management, change management,…