Director of Payer Contracting - Ambulatory, Transplant and Ancillary Services

                    

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

Director of Payer Contracting - Ambulatory, Transplant and Ancillary Services

                        

Location

Cleveland

                    

Facility

Remote Location

                     

Department

Market and Network Services MNS-Finance

                      

Job Code

T97574

                     

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 Director of Payer Contracting – Ambulatory, Transplant, and Ancillary Services leads national payer contracting and network growth for ASCs, Transplant and Gene Therapy programs and Ancillary Services. In this position, you will partner with cross functional teams including pricing, managed care, operations, analytics, finance, joint venture and physician partners and clinical leadership to align contracts with financial goals and care delivery models. This candidate will drive value-based payment initiatives, oversee payer relationships, ensure compliance and lead a high performing contracting team.

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:

• Partner with internal stakeholders and joint venture partners to identify growth opportunities and expand the clinically integrated network.

• Lead the development of business plans and product strategies to support population health, risk capture, ASC, Transplant, Gene Therapy and Ancillary Service expansion.

• Seek new market opportunities in OH, FL, NV and elsewhere to expand payer and provider relationships through innovative contracting solutions.               

• Ensure contract operationalization in partnership with revenue cycle, finance, joint venture teams and clinical institutes.

• Develop tools and workflows for efficient contract modeling, performance tracking and implementation.

• Manage the communication and approval process for new and renew contracts, including reporting to Sr. Director - Payer Contracting, Executive Leadership and Joint Venture Boards.                                                                                

• Cultivate and maintain strong payer relationships to facilitate favorable negotiations and long-term partnership success.

• Communicate complex contractual elements and ensure alignment with internal revenue cycle and clinical operations.

• Identify and escalate payer issues with appropriate internal stakeholders.

• Lead the ASC, Transplant, Gene Therapy and Ancillary Contracting team, ensuring appropriate delegation of responsibilities, resource utilization and adherence to policies.

• Provide leadership coaching, mentoring, guidance and support for team development and performance.

• Monitor compliance with contract terms, government regulations and CCF organizational standards.

Minimum qualifications for the ideal future caregiver include:

• Bachelor’s degree in healthcare administration, Business, Finance or a related field and ten years of healthcare payer contracting, including ASC's, transplants, ancillary services, or multi-specialty practice settings

• Seven years of leadership or management role within a healthcare system or contracting department

• Deep understanding of healthcare payer markets, reimbursement models, provider network structures, joint venture and physician partner relationships

• Strong negotiation, relationship management and conflict resolution skills.

• Excellent analytical and financial modeling capabilities

• Proficient with Microsoft Office a