Vice President, Payer Strategy

Summa Health System-Finance Administration

Summa Health System is recognized as one of the region’s top employers by a number of third party organizations, including NorthCoast 99. Exceptional candidates gravitate to Summa because of its culture, passion for delivering excellent service to our patients and families commitment to our philosophy of servant leadership, collegial working relationships at every level of the organization and competitive pay and benefits.
Summary:
Assumes responsibility for integrating and aligning Payer Strategy with Summa Health’s strategic objectives, including population health strategies, value-based contracting strategies, contract management and operations processes and government reimbursement trends. This role leads the overall integration and alignment of Payer Strategy across Summa Health, including Summa Health Network (SHN, a physician hospital organization), NewHealth Collaborative (NHC, an accountable care organization), Summa Health System hospitals, Summa Health Medical Group, Summa Rehab Hospital, Summa Health at Home and Summa Hospice and SummaCare Health Plan. This also includes integration (relative to payer strategy) across key Summa Health functional areas of Revenue Cycle Management, Finance, Reimbursement, Legal, Business Development and Health Plan Operations.

• Oversees payer contracting which includes fee for service contracts and alternative payment models (APM) based on quality, episode costs, and total cost of care.
• Oversees the operations required to analyze, implement and monitor the performance of all fee for service and value-based payer agreements.
• This position is the focal point for education on managed care and value based contracting issues (i.e. Incentive Structures, Bundled Payments, Gain Sharing and all forms of Capitation)

Overall, ensures that the above activities are consistent with the operating goals and the mission, vision and values of Summa Health. Develop and implement strategies to grow the population base, achieve effective integration and advance the clinical enterprise.



Minimum Qualifications:

Formal Education Required:

• Bachelor’s Degree required. Graduate level work or Master’s Degree in Finance, Management, or a related course of study preferred

Experience & Training Required:

• Ten (10) years experience in healthcare environment that has provided knowledge of healthcare reimbursement, managed care delivery systems, or contract negotiations

Other Skills, Competencies and Qualifications:

• Working knowledge base of all business units within a large integrated health system
• Excellent verbal and written communication skills. Serves as the front-facing executive for Summa on all payer related matters.
• Extensive experience in negotiations with C-Suite executives from the employer to the payer arena required
• Current knowledge of managed care delivery systems including hospital, medical group, accountable care organization, physician hospital organization and health plan operations
• Knowledge of value-based care models including bundle payment negotiation, pay for performance initiatives, shared savings, risk pools and capitation
• Extensive knowledge of language interpretation in managed care contracts
• Extensive knowledge of rate methodologies and financial models utilized in hospital, physician, ancillary and value based contracting
• Ability to maintain confidentiality of patient and other proprietary information
• Ability to articulate and implement required changes within the organization as needed to support the population health strategies and objectives
• Ability to understand and communicate recognized trends and potential changes within the managed care market
• Assumes accountability for demonstrating behaviors consistent with the customer service policy

Population Specific Competency: ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

Level of Physical Demands:

• Sedentary: Exerts up to ten pounds of force occasionally and/or a negligible amount of force frequently
  

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