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\nresponsible for overseeing health plan contracting, contract implementation and\nongoing contract management for assigned Payers and entity relationships. The\nposition deals with external constituents, including managed care payers,\nemployers, third party administrators and insurance companies, as well as\ninternal constituents within the Yale-New Haven Health System and/or the Yale\nSchool of Medicine. Contracts are negotiated and coordinated in conjunction\nwith the VP, Payer Strategy and Innovation and with appropriate representatives\nof the Yale School of Medicine.
1. Negotiates with managed care organizations and/or\ninsurers to obtain provider services agreements that advance the profitable\ngrowth of Yale New Haven Health System and/or Yale School of Medicine. Many\nagreements are negotiated directly by incumbent. Several major agreements may\nbe negotiated in conjunction with the VP, Payer Strategy and Innovation and/or with\nrepresentatives of the Yale School of Medicine. \n\n2. Ensures that provider agreements can be supported and key\ndeliverables or performance targets upheld in advance of committing the\norganization to their terms. Upon receipt of proposed contracts, performs objective\ndata analysis to ensure completeness and financial acceptance with agreed upon\nterms. \n\n3. Responsible for proactively managing timeframes for\ncontracts and obtaining fee schedule changes and contract terms in a timely\nmanner for new contracts and at or prior to contractual renewal date for\ncontract renewals. \n\n4. Responsible for delivering critical information\nconcerning covered services, par providers, carve-outs and fee schedules to\naffected internal clients in a timely manner; facilitates clear and unequivocal\ncommunications between contractors and health system clientele as necessary to\nensure smooth implementation of agreements. \n\n5. Maintains a keen awareness of the external business\nenvironment and most -likely prospects for garnering new payer agreements\nand/or favorable payment provisions. \n\n6. Supports quality program initiatives and ensures that the\nrelevant standards are upheld in all contracting ventures. Prepares and\ndelivers comprehensive presentations on managed care initiatives and status of\nagreements to various Yale New Haven Health System and Yale School of Medicine\nconstituents. \n\n7. Strategically assess and develops managed care\nopportunities to improve and solidify revenues. Leads assigned teams to address\nmajor projects involving the development of system wide initiatives in managed\ncare contracting. Evaluates scope, plans and designs steps, timelines and\nforeseeable deliverables; writes supporting proposals and summarizes completed\nprojects. \n\n8. Cultivates effective partnerships with internal\nstakeholders and colleagues to present a cohesive and proactive team approach\nto meeting client needs. Participates substantially on working teams from\nhospital, health system and Medical School to bring about seamless and\nconsistent contracts beneficial to the providers across the spectrum of care.
Bachelors Degree (Masters Preferred) in\nbusiness, public health, health care administration or related field.
Minimum of five to seven years\ncontracting experience in progressively responsible management roles within a\nhealth care setting.
Exceptional communication skills, both\nverbal and written. Ability to articulate complex issues via presentations to senior\nmanagement. Solid understanding of managed care, payment approaches, risk and\ncapitation and managed care financial models. Demonstrated skills in data\nanalysis and reporting. Excellent negotiation and partnering skills. Ability to\nmake tough decisions with confidence. Ability to deal with ambiguity.\nOperational understanding of planning and marketing, finance, business office\nsystems, human resources, hospital operations and medical staff leadership.\nPolitical savvy, strong ethics and teamwork skills. Accountable and\nself-directed with appropriate engagement of leadership support. *CB