Job Details

This position leads strategic payer contracting initiatives to support the Enterprise's growth, financial performance, and quality outcomes. In partnership with senior leadership, this role develops and implements innovative payer relationships and next-generation contracting models.

Job Description

This position is for Leigh Valley Health Network part of Jefferson Health.

• Leads regional payer–provider contracting strategies, including utilization, care and disease management, claims, and network development.
• Serves as single point of contact for senior leadership on assigned payers for all issues, demonstrating working knowledge of the Enterprise's Fee For Service, Payment Compliance and Value Based Reimbursement strategies.
• Prioritizes the work for the Fee For Service team, facilitating collaboration with Payment Compliance and VBR Contracting teams.
• Maintains awareness of payment compliance issues. Partners with finance, clinical, legal, and analytics teams to optimize performance and resolve complex issues.
• Builds and maintains strong relationships with payers and provider organizations.
• Collaborates with senior leadership to align contracts with enterprise goals.
• Ensures day to day operations support strategic objectives.
• Navigates ambiguity and drive alignment across stakeholders

Education - Required

• Bachelor’s Degree Business, Health Administration, Finance, or related field

Education - Preferred

• Master’s Degree Business, Health Administration, Finance, or related field

Experience - Required

• 10 years Experience in leading significant negotiations on behalf of a health plan or health system. and
• 10 years Managing Teams and
• 10 years Strong contracting expertise in negotiating and managing agreements across diverse fee-for-service models, including Commercial, Medicare Advantage, and Managed Medicaid, ensuring compliance and optimizing reimbursement strategies.

Knowledge, Skills and Abilities - Required

• Skilled negotiator with excellent quantitative, oral and written communication skills that have been tempered through complex managed healthcare contract negotiations.
• Ability to handle multiple projects and perform independently under tight deadlines with a focus on effective implementation, clear and consistent communication and follow-up.
• Energetic, collaborative and mission-oriented, with a track record of creating collaborative, transparent provider-payer relationships
• Deep understanding of industry trends and analyses; ability to turn insights into organizational roadmap for market expansion and innovative contracting strategy.
• Proven ability to think strategically, problem solve and create momentum through ambiguity.
• Ability to thrive in a fast-paced, agile work environment with high expectations and accountability.
• Requires comprehensive leadership and decision-making skills, a demonstrated aptitude for analytical thinking and an ability to report findings in an accurate manner.
• Requires the ability to work effectively with all levels of management and physicians.
• Solid foundational knowledge of Value-Based contracting and Delegated Credentialing processes

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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