The Senior Vice President of Strategic Payer Relations is a key leader who collaborates with payers and government provider services organizations to drive value-based care through a digital health care platform. Our goal is to achieve the Quadruple Aim - improving quality, cost, patient satisfaction and physician experience - by working with all key industry stakeholders including health systems, payors/employers, physician providers and patients.
The Senior Vice President of Strategic Payer Relations is responsible for leading initiatives to create innovative and transformative payer strategies, relationships and agreements that drive the future of Recovery Centers of America (RCA) by optimizing revenue and increasing the number of people we serve. This role will lead the Payer Strategy Innovation team in developing payer strategies to advance strategic partnerships, new care delivery/service reimbursement models, value-based agreement strategy and growth, and overall efforts to innovative payer strategies to maximize value for the patient, payer and RCA.
This role will help improve outcomes and lower costs by using contract models - including bundled payments - with value- based incentives and payment structures, building and sustaining high-value networks and creating collaborative partnerships.
The Senior Vice President will develop data driven methods to increase delivery of services and cut costs for employers and corporations while maintaining the high quality of service. The technologically enhanced services of RCA offer the Senior Vice President avenues for creating and enhancing services.
This role positions RCA for sustainable financial performance through sophistication and innovation in payer strategies and the translation of provider/system value into payer reimbursement strategies. The Senior Vice President of Strategic Payer Relations is a key member of the RCA leadership team, directly interacting with executive leaders across the organization.
KEY RESPONSIBILITIES
- Develop strategy to advance strategic partnerships, new care delivery/service reimbursement models, value-based agreement strategy and growth, and overall efforts to maximize the value of strategic payer partnerships for the patient, payer and RCA.
- Lead, manage, mentor and develop Payer Strategy team that consists of five regional Vice Presidents.
- Assess readiness for value-based contracting and outline keys for success.
- Utilize advanced data analytics to package all fees into one value-based bundle, resulting in lower costs to payors, health systems, employers and patients.
- Achieve provider and payer goals through contract arrangements to ensure successful value-based relationship.
- Manage financial risks and data-sharing challenges in risk-bearing reimbursement models.
- Optimize strategies to achieve positive financial and clinical outcomes through specialty bundles.
- Directly engages with senior leadership team across RCA to design strategic initiatives that influence payer and employer strategies.
- Engages in cross-functional initiatives to drive integration and alignment across RCA to improve operational and financial performance.
- Evaluates innovative payer partnership opportunities to ensure alignment with RCA's strategies.
- Develops, implements and monitors success of innovative national and local payer partnership strategies to drive sustainable financial performance.
- Designs strategy and manages system participation and performance in novel innovative care models to ensure appropriate reimbursement models accompany program participation.
- Designs and implements reimbursement strategies for new services/care delivery models to optimize revenue and margin (telehealth, hospital at home, etc.)
- Collaborates with System and Division Finance, Legal, Business Development and Network Operations areas to advance alignment and accountability in order to maximize the value of payer contracts for the patient, payer and RCA.
- Monitor emerging payer trends, new reimbursement methodologies, payer activity, products and delivery channels.
SKILLS AND EDUCATION
- A bachelor's degree is required; a master's degree in business or healthcare administration is strongly preferred
- 15+ years industry experience
- 10+ years progressive leadership responsibility and experience in large healthcare organizations
- 5-10 years strategic management of healthcare pricing, contract negotiation and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment
- Experience working with both provider and payer organizations is preferred
- Experience in value-based reimbursement model development
- Demonstrated success in leading, implementing and managing financial performance of payer contracts