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Position:Payer Contracting Director

Position Summary:Responsible for consulting with external partners on the planning, direction, and implementation of payer relationships and provides expertise on negotiating and executing value-based contracts. Utilizes a deep marketplace expertise to serve as a strategic thought partner to adjust strategies and meet high standards of contract development, contract language, drafting, analysis, and negotiation. Participates in the development of strategies and methodologies as it relates to payer contracting, contract terms, and alternatives for all contracts. Provides consultative support to external executive teams on organization wide contracting efforts.

Job Description:

Primary Responsibilities

Identifies and recommends opportunities for all forms of value-based contract performance improvement with existing customer contracts.Collaborates with cross-functional teams to develop solutions, gain alignment, and deliver impactful business insights. Engages with necessary internal business partners to enable strategic direction.Influences and educates various external and internal business partners on contracting strategies, marketplace dynamics, customer insights, patient healthcare trends, portfolio considerations, communities of practice, and payer payment innovations.Educates external and internal business partners on market movement that influence and impact work including current and proposed government policy, reimbursement landscape, payer trends, distribution dynamics, and legal considerations.Utilizes depth and breadth of contracting and negotiation knowledge to develop and communicate managed care contract execution strategies that support clients moving to fee-for-value types of contracts.Designs and implements negotiation strategies for the terms and conditions in value-based contracts.Owns and is accountable for project performance, risk management, administration, financial management, and issue resolution for self-identified or assigned projects with significant scope.Shares insights to elevate team-thinking and promote a balanced, holistic point of view around the movement to fee-for-value strategies. Effectively weighs and communicates trade-off considerations.Addresses complex, strategic business issues and completes work that has significant business impact.Develops and provides plan support and contracting guidance as needed.Compiles, maintains, and reviews client's value-based contracts and risk contracts portfolio for the purpose of identifying opportunities to improve contract performance and structures.Reviews and recommends resolutions of contract barriers, taking into account prevailing local market information.

Qualifications

Bachelor's Degree or equivalent12+ years of relevant experience in managed care or the knowledge, skills, and abilities to succeed in the roleAdvanced knowledge and ample experience in managed care contracting with a broad range of providersComprehensive knowledge of and experience in value-based care and risk-based contractingExcellent project management skills with the proven ability to yield resultsExpert knowledge of provider contracting/negotiations, network development and configuration, standards for value-based contracting, and managed care deliverySubstantive knowledge of population health, value-based care, and managed care policy and directionStrong communication and negotiation skillsDemonstrated executive presence with the ability to influence at all levels internally and externally#LI-REMOTE

PreferredBachelor's degree in managed health care, legal, or finance discipline

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$113,800.00-$154,525.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position: No- Not Member or Patient Facing Position

Location:United States

Time Type:Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.