SCL Health is a faith-based, nonprofit healthcare organization dedicated to improving the health of the people and communities we serve, especially those who are poor and vulnerable. Founded by the Sisters of Charity of Leavenworth in 1864, our $2.6 billion health network provides comprehensive, coordinated care through 10 hospitals, more than 100 physician clinics, and home health, hospice, mental health and safety-net services primarily in Colorado and Montana. We relentlessly focus on delivering safe, high-quality, effective care to every patient, every time, everywhere. In 2016, SCL Health invested $257 million in community benefit —10 cents of every dollar we earn—to support health improvement in our communities.
Every company has a mission statement on its wall, but here the mission lives in our hearts and actions. No matter what part you play or which role you fill, you are improving the lives of the people and communities we serve, especially those who are poor and vulnerable. Our values and culture tie us together, and we recognize that a caring smile or kind word contribute to our success as much as the job itself.
You deserve to work for a place that allows you to take care of yourself and your family and focuses on taking care of the whole person. We provide competitive benefits and salaries in all the communities we serve. For full-time employees we provide:
- Retirement plans
- Medical, dental and vision insurance
- Paid time off
- Corporate discounts for certain products and services
- An employee wellness program that includes financial incentives
- Education reimbursement
The Vice President Payer Contracting is responsible for the strategic direction, leadership and implementation of SCL Health payer contracting for its acute care facilities, employed medical groups, outpatient/ambulatory services, joint venture arrangements, and existing and to be developed clinically integrated networks. The VP Payer Contracting oversees managed care/health plan analytics and payer auditing, contract management systems and payer relations. The VP Payer Relations must understand the needs, strategies and goals of each of the individual regions within SCL Health while developing and implementing a comprehensive and integrated contracting strategy for SCL Health. Through, expertise, innovation, leadership and collaboration with payers, benefits consultants, TPAs, providers, government agencies, private exchanges and employers, the Vice President Payer Contracting will create a successful business model that enables SCL Health to sustain its mission.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- -Interact with System and regional leadership in communicating the strategic vision for payer contracting and strategy, government program strategies and implementation (ie, Medicare Advantage plans, managed Medicaid, TriCare, Veterans Affairs programs) and in supporting implementation of associated strategies and initiatives so they are uniformly deployed across SCL Health.
- -Develop strategies with a focus on: maximization of profitable growth; effective and efficient operations; leveraging of best practices; standardization of systems and practices; driving continuous improvement, innovation, and quality; facilitation/acceleration of performance-based, shared savings and future risk contracting opportunities and, consistency with SCL Health's mission and values.
- -Develop and implement policies and procedures, short and long-term goals, objectives and plans related to contracting strategies.
- -Assess current managed care strategies and contracts relative to the marketplace and ensure that successful contracts are (re)negotiated and produce win-win situations for SCL Health and payers.
- -Monitor, track and evaluate federal and state legislative matters, proposed and passed federal and state legislation effecting the health care industry and SCL Health specifically and provide guidance, input and direction as to how best react and effectively manage and administer such legislation impacting SCL Health.
- -Evaluates and reviews market opportunities for direct-to-employer contracting.
- -Develops and maintains systems for contract evaluation, implementation and ongoing performance monitoring.
- -Develops and maintains relationship with key payer executives and ACO leaders.
- -Collaborate with payers to understand their strategies, recommend organizations for close alignment, and design narrow networks.
- -Work collaboratively with Finance, Legal, Compliance and Strategy teams to align Payer Contracting to meet the requirements of Health Care Reform and emerging market
- -Develop clear packaged pricing models to identify and intervene with at risk patients
- -Develop clear packaged pricing models and retail price transparency for patients.
- -Promotes mission, vision, and values of SCL Health, and abides by service behavior standards.
Required : Bachelors Degree from an accredited College or University in Health Administration, Business Administration, or Finance.
Preferred : Masters Degree from an accredited College or University in Health Administration, Business Administration, or Finance.
Required : Fifteen (15) years of related executive level experience from the health care industry. Masters Degree may substitute for five (5) years of experience.
Preferred : Experience from the Health Insurance industry
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of current healthcare, social and regulatory trends
- Innovative and creative with the ability to develop new markets and business opportunities
- Entrepreneurial orientation
- Strategic leader with sound technical and analytical abilities
- Leadership presence and the ability to represent SCL Health at a national level
- Effective and comfortable working in a matrixed organization within a healthcare system at the System Service level
- Excellent interpersonal, negotiation, oral and written communication skills and is able to meaningfully communicate with diverse stakeholder
- Self-motivated, high performer with energy and enthusiasm for this role ? and passionate about improving the delivery of safe, high-quality healthcare to patients
- Achievements in bringing disparate groups together and communication with all levels
- Strong relationship building and partnering skills; engage with physicians and staff at a fundamental level
- Works independently and maintains open and regular communications with the Board of Directors and senior executive leaders across SCL Health