Assistant Director, Payer Contracting and Business Development

This a Full Remote job, the offer is available from: United States At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Assistant Director, Payer Contracting and Business Development Location Cleveland Facility Remote Location Department Market and Network Services MNS-Finance Job Code T98125 Shift Days Schedule 8:00am-5:00pm Job Summary Job Details Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. The Assistant Director Business Development and Payer Contracting partners with leadership to develop and implement payer contracting and business development growth strategies and processes, payer operations processes. In this position, you will manage relationships with third-party payers, community physicians, and employers. Works with partners to develop analytics to support contract negotiation, growth strategies, risk capture, population health and contract analysis and implementation efforts as well as product strategies and payer operations. A caregiver in this role works remotely from 8:00 a.m. – 5:00 p.m. Candidates for this position are preferred to reside in Ohio, Nevada, or Florida. A caregiver who excels in this role will:

• Analyze markets from a strategic perspective, develop managed care strategies and tactics by market, nationally and at the state level.
• Provide work direction and leadership to regional and national caregivers teams within MNS to support the following lines of business including but not limited to: Medicaid, transplants, centers of excellence, regional PPOs, and single case agreements.
• Develop and implement market and network services goals including but not limited to managed care contracting goals and objectives ensures their execution.
• Recommend and gain support from MNS leadership, institute leaders and operations to ensure optimal implementation of the business development and managed care contracting strategies.
• Maintain awareness of market, payer, and competitive managed care activities and adjust strategies accordingly.
• Work with contract managers, operations, and clinical caregivers to ensure effective implementation of new and renegotiated contracts and to resolve problem payer issues.
• Communicate effectively with leadership, operations, and contract managers on the status of contracting and problem payer issues.
• Review and negotiate contract language and pricing terms in accordance with budgetary objectives and policy and procedures to maximize benefit to the company.
• Represent the company to payers and regulatory authorities in matters related to payer account management. Manages not less than 1/3 of the net reimbursement from managed care payers.
• Effectively communicates trends and issues to corporate managed care through ad hoc communications, monthly and quarterly reports.
• Work with corporate managed care to recommend changes in contracting and reimbursement guidelines to ensure achievement of reimbursement maximization as it relates to managed care.
• Develop playbooks for contracting segments including but not limited to transplant, vision, dental, behavioral health, and value-based contracting to aid in the development of the contract managers and senior contract managers.

Minimum qualifications for the ideal future caregiver include:

• Bachelor’s degree in Finance, Accounting, Business, or Healthcare Administration or related field.
• Ten years healthcare management experience in a managed care environment.
• Extensive knowledge of healthcare planning, finance, marketing, reimbursement, operations, and related activities.
• Experience leading process improvement activities across cross functional teams and organization

Preferred qualifications for the ideal future caregiver include:

• Master’s degree
• Experience managing contracts for regional systems offering comprehensive services
• Experience working with various insurance plans and diverse healthcare services

Physical Requirements:

• Requires prolonged periods of sitting with a light amount of physical work, with maximum lifting of 20 pounds.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. Please review the Equal Employment Opportunity poster. Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities This offer from "Cleveland Clinic" has been enriched by Jobgether.com and got a 78% flex score. Apply tot his job Apply To this Job