To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
This position is a senior managed care position and
responsible for overseeing health plan contracting, contract implementation and
ongoing contract management for assigned Payers and entity relationships. The
position deals with external constituents, including managed care payers,
employers, third party administrators and insurance companies, as well as
internal constituents within the Yale-New Haven Health System and/or the Yale
School of Medicine. Contracts are negotiated and coordinated in conjunction
with the VP, Payer Strategy and Innovation and with appropriate representatives
of the Yale School of Medicine.
1. Negotiates with managed care organizations and/or
insurers to obtain provider services agreements that advance the profitable
growth of Yale New Haven Health System and/or Yale School of Medicine. Many
agreements are negotiated directly by incumbent. Several major agreements may
be negotiated in conjunction with the VP, Payer Strategy and Innovation and/or with
representatives of the Yale School of Medicine.
2. Ensures that provider agreements can be supported and key
deliverables or performance targets upheld in advance of committing the
organization to their terms. Upon receipt of proposed contracts, performs objective
data analysis to ensure completeness and financial acceptance with agreed upon
3. Responsible for proactively managing timeframes for
contracts and obtaining fee schedule changes and contract terms in a timely
manner for new contracts and at or prior to contractual renewal date for
4. Responsible for delivering critical information
concerning covered services, par providers, carve-outs and fee schedules to
affected internal clients in a timely manner; facilitates clear and unequivocal
communications between contractors and health system clientele as necessary to
ensure smooth implementation of agreements.
5. Maintains a keen awareness of the external business
environment and most -likely prospects for garnering new payer agreements
and/or favorable payment provisions.
6. Supports quality program initiatives and ensures that the
relevant standards are upheld in all contracting ventures. Prepares and
delivers comprehensive presentations on managed care initiatives and status of
agreements to various Yale New Haven Health System and Yale School of Medicine
7. Strategically assess and develops managed care
opportunities to improve and solidify revenues. Leads assigned teams to address
major projects involving the development of system wide initiatives in managed
care contracting. Evaluates scope, plans and designs steps, timelines and
foreseeable deliverables; writes supporting proposals and summarizes completed
8. Cultivates effective partnerships with internal
stakeholders and colleagues to present a cohesive and proactive team approach
to meeting client needs. Participates substantially on working teams from
hospital, health system and Medical School to bring about seamless and
consistent contracts beneficial to the providers across the spectrum of care.
Bachelors Degree (Masters Preferred) in
business, public health, health care administration or related field.
Minimum of five to seven years
contracting experience in progressively responsible management roles within a
health care setting.
Exceptional communication skills, both
verbal and written. Ability to articulate complex issues via presentations to senior
management. Solid understanding of managed care, payment approaches, risk and
capitation and managed care financial models. Demonstrated skills in data
analysis and reporting. Excellent negotiation and partnering skills. Ability to
make tough decisions with confidence. Ability to deal with ambiguity.
Operational understanding of planning and marketing, finance, business office
systems, human resources, hospital operations and medical staff leadership.
Political savvy, strong ethics and teamwork skills. Accountable and
self-directed with appropriate engagement of leadership support.