Sr. Manager of Negotiation Job in Lake Mary, Florida US
Description
Job duties include but are not limited to the following:
*Responsible for negotiating Delivery System’s alternative payment models / contracts including ACO, PCMH and P4P models with physicians, hospitals and ancillary providers for both commercial and Medicare advantage lines of business.
*Delivers provider agreements that align incentives with select providers in an effort to create value for our members and protect their access to affordable healthcare.
*Understand the Delivery System strategy, Health Care Reform, the Exchanges, and key components of transforming the health care delivery system
*Working knowledge of various payment methodologies to help transform incentives in paying for health care and preventative services such as bundled payments, capitation, pay for performance, gain sharing and other risk strategies.
*Understand outside vendor capabilities as well as internal resources available to support care transformation and payment reform.
*Proven ability to influence both internal and external stakeholders via proven negotiation or provider relation effectiveness.
*Reviews and validates information, processes and designs developed and analyzed by staff to ensure the design supports the defined solution.
*Monitors the market place for new healthcare delivery/alternative payment arrangement innovations, competitor activity, provider trends and emerging technologies.
*Develops concept description with recommendations, for presentation to key internal constituents and/or external providers.
*Assigns work, provides direction, performs coaching and oversight of direct staff.
*Possess a deep understanding of provider contract language.
Job Requirements:
*Bachelors’ degree or equivalent work experience
* 6 or more years of experience in the health care industry negotiating alternative payment models / contracts including ACO, PCMH and P4P models with physicians, hospitals and ancillary providers for both commercial and Medicare advantage lines of business
*Experience working with physician and/or hospital contracting, medical homes, and P4P programs
*Experience working with healthcare economics / analytical and quality metrics.
*Experience with communicating effectively across the organization and at different levels
*Experience communicating with complex provider organizations
*Overnight periodic travel (up to 25%)
Business Specific Criteria (preferred skills):
*Working product knowledge
*Experience working with clinical / gap-in-care
*Experience working with Health benefit product
*Experience with Medicare risk arrangements