Job Details

The Director of Payor Strategy and Population Health is responsible for leading Managed Care Negotiations and Relationship Maintenance, including reimbursement rates, administrative requirements, language, and terms. This role serves as the primary liaison with payors for all issues beyond contracting, including escalation of disputes and problems, innovative business relationships, and other direct engagements with the payors and intermediate entities on behalf of our national team.

This position represents a significantly rewarding career opportunity to join the largest and fast-growing retina practice management company, admired for its people, partnership model, and performance - Retina Consultants of America - is a team of highly talented and experienced people investing in clinical trials and innovative partnerships with payors and pharmaceutical companies, working together on mission to preserve eyesight for patients across America.

Responsibilities

• Assess macro trends and market specific nuance to determine opportunities by market and payor, and to craft a compelling pitch to meet and exceed goals for rates, prior auth pass/gold-carding, population health incentives, etc.
• Review health plan agreements and fee schedules of acquisition targets to assess and craft recommended integration strategies to optimize value to stakeholders.
• Represent Retina Consultants or America and our regional teams in negotiations with managed care and intermediary relationships nationally to meet and exceed our goals for rates, efficiency, and value-based care.
• Maintain contract management platform with all agreements and fee schedules
• Work with Financial Planning and Analytics to verify the financial impact of new contracts and to develop budgets based on confidence in future year(s) proposals.
• Collaborate closely with cross-functional and national stakeholders to monitor and report on key market trends that identify relative pricing, health plan trends, revenue enhancement opportunities and develop and implement solutions for under- performing program contracts, including improvements in denials and Underpayments.
• Prepare reporting and analytics to support and justify recommendations for internal and external use.
  

Education and Work Experience

• Bachelor’s Degree in accounting, finance, or business administration. A Master’s degree in Business, Healthcare, Public Health Administration is preferred, but not required.
• 5+ years of contracting, negotiations. and health plan portfolio management experience in specialty medicine, private equity, or health care contracting
• Deep experience in understanding healthcare field – understanding parameters around how payers and providers are working, how they work together, and how analytics and aligning incentives is enabling transformation.
• Experience in a high growth, fast-paced, high pressure, constantly changing environment; private equity and or start-up experience preferred.

Skills and Knowledge

• Strong analytical skills, with extreme attention to detail, accuracy and accountability balanced with sound business judgment.
• Ability taking ownership over health plan relationships for the purposes of negotiations.
• Demonstrated ability to leverage data, insights, and effective communication strategies to influence stakeholders, navigate complex discussions, and achieve business objectives.
• Possess a strong detail orientation; seeks appropriate amount of data and information to make decisions; sorts and categorizes information quickly; prioritizes data points in decision making process.
• Ability to build constructive relationships in furtherance of organizational goals and priorities.
• Adept at managing highly collaborative, matrix relationships across the organization, with area practice management boards, and equity partners, etc.
• Possess strong interpersonal skills to effectively collaborate with cross-functional teams including associates and executives at all levels of the organization.
• Excellent professional written/verbal communication and interpersonal skills, coupled with a strong executive presence and ability to communicate compelling, influential messages to internal and external stakeholders of all levels.
• Commitment and ability to work hands-on with a sense of urgency, ability to collaborate and deliver an excellent work product in a fast-paced, and rapidly growing dynamic company.

Schedule

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Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.

The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.

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