Regional Director, Managed Care

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Responsible for developing and maintaining long-term productive relationships with practices in The US Oncology Network and third-party payers, such as commercial and governmental payers, employers, and other payer organizations. Leads a team of managed care professionals and directs the execution of managed care initiatives and strategies that will maximize opportunities between third-party payers and provider partners including hospitals, PCP networks, and employer groups.

Negotiates contracts with payers that meet the financial, operational, and strategic goals and objectives for assigned practices within The US Oncology Network and coaches team to similarly perform these duties.  Partners with key stakeholders and subject matter experts to develop an understanding of new therapies, technologies, and procedures, and to ensure that costs are appropriately reflected and reimbursed in managed care agreements. Collaborates with senior leaders on the development of long and short-term practice-level strategic plans that position practices optimally within the third-party payer environment and local hospital/provider market.

Key Responsibilities

Collaborate with key stakeholders to develop and execute both fee for service and value based contracting strategies

• Build self as a trusted, expert advisor with stakeholders. Provide support to teams on issues of managed care strategy, reimbursement, cost, payer mix, and other contract-specific issues. Respond to requests for assistance in resolving a wide range of contract performance and operational issues associated with the implementation of contracts.
• Recommend budget and advise senior management both within The US Oncology Network and practice leadership on all matters concerning net revenues in the areas of commercial Managed Care, Medicaid, and Medicare. 
• Ensure timely and effective implementation of contracts through communication with key team members.
• Collaborate with multiple internal groups which contribute to this business (US Oncology operations, Finance, Innovent, Clinical Services, Pharmacy Solutions, Revenue Cycle, VBC Transformation, and Medically Integrated Pharmacy, Business Development).
• Partner with Impacts Analytics to develop and evaluate contracts to optimize pricing and strategically align payer, practice, and physician incentives. Design sound agreements that drive compelling performance and optimization of quality measurements based on claims studies, actuarial evaluations, and episodic payments where gain/risk share, steerage, or other advantages to the practice are involved. 
• Collaborate with key stakeholders to design paths that prepare practices for novel payment models (i.e., case rate development, integrated networks, contract capitation, total cost of care initiatives, and shared savings models) and have a firm grasp on the analytics/practice impacts that support such payment models.

Develop and strengthen payer relationships

• Responsible for the successful negotiation and management of designated payer agreements, including developing, evaluating and implementing, and establishing profitable payer relationships to achieve the organization’s objectives, grow and protect revenue, and support value-based care transformation across assigned practices.
• Develop and maintain payer relationships and advocate for community-based oncology services with local market payers; identifying opportunities and programs to secure enhanced relationships, reimbursement, referrals, and market presence and support expansion of patient services.
• Executes new preferred provider agreements, novel payment arrangements, and enhanced fee-for-service agreements aligned with strategic imperatives.
• Provide leadership and development of contracting team members, including McKesson and USON practice employees across multiple geographies
• Responsible for goal setting and performance management of direct reports
• Responsible for professional development and guidance of all team members and disciplines
• Ensures direct reports’ accountability
• Support leadership bench strength and support development for cross-functional partners

Minimu