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.
Position reports to the Director of Payer Relations and Contracting, Yale New Haven Health System. This position is a senior managed care position responsible for provider and health plan contracting, contract implementation and ongoing contract management for Yale-New Haven Hospital, Bridgeport Hospital, Greenwich Hospital, Northeast Medical Group, Yale Medicine, behavioral health vendors, single case agreements and other contracting requirements. The position deals with executive level external constituents, including managed care payers, managed care vendors, employers, third party administrators and insurance companies, as well as internal constituents? within Y-NHH, including System Business Office, Finance and senior managers of the hospital(s). Contracts are negotiated and coordinated in conjunction with the Director of Payer Relations and Contracting.
- 1. Negotiates with managed care organizations and/or insurers to obtain provider services agreements that advance the profitable growth of Yale-New Haven Hospital, Bridgeport Hospital, Greenwich Hospital, NEMG and other contracting requirements. Many agreements are negotiated directly by incumbent. Several major agreements may be negotiated in conjunction with the VP Payer Relations.
- 2. Ensures that provider services agreements can be administered, supported and key deliverables or performance targets upheld in advance of committing the organization to their terms.
- 3. Responsible for delivering critical information concerning covered services, par providers, carve-outs and fee schedules to affected internal clients in a timely manner; facilities clear and unequivocal communications between contractors and health system clientele as necessary to ensure smooth implementation of agreements.
- 4. Maintains a keen awareness of the external business environment and most-likely prospects for garnering new payer agreements and/or favorable payment provisions.
- 5. Supports the hospital?s quality program initiatives and ensures that the relevant standards are upheld in all contracting ventures.
- 6. Cultivates effective partnerships with internal hospital and health system colleagues to present a cohesive and proactive team approach to meeting client needs.
- 7. Evaluates the existing contractual payment arrangements, builds contracts in modeling software accounting for all elements of these complicated agreements, reconciles the data and validates payments to assure accuracy in negotiations of rates, terms and provisions.
- 8. Negotiates contractual language supporting rate requirements, administrative implementation standards and guidelines and provisions in accordance with the interests of YNHHS and mutually agreed terms and conditions.
- 9. Directly supervises analysts responsible for supporting the Departmen'ts contracting initiatives.
Bachelor's Degree, Masters Preferred, in business, public health, health care administration or related field.
A minimum of six years contracting experience in progressively responsible management roles within a healthcare setting.
Exceptional communication skills, both verbal and written. Solid understanding of managed care, payment approaches, risk and capitation and managed care financial models. 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. Strong excel and contract modeling tool skills to support negotiations.