Region Director Payer Strategy
Location: Rancho Cordova
Posted on: June 23, 2025
|
|
Job Description:
The Regional Director, Payer Strategy and Relationships (PSR),
is a remote position and is responsible for managed care policies,
goals and objectives related to contract language and reimbursement
(capitation, fee-for-service, and quality incentive programs),
negotiation strategy, and payer relationships for all Physician
Enterprise and hospital-based clinic physician entities across
California. There are currently 12 Medical Groups with 160 clinic
sites and over 5,000 physicians in our medical networks. It is
preferred that the candidate resides in the California market and
must have extensive experience working with California health plans
and IPAs. The Regional Director is primarily focused on payer
relationships and health plan contracting for all managed care
lines of business and collects and communicates Region-level
insight and strategic knowledge to/from the PSR National Payer
teams, Physician Enterprise, the PSR Growth & Innovation team, and
other key departments across the enterprise. This position is
essential to CommonSpirit Health’s financial performance, and has
significant impact on the long-term strategic trajectory of the
organization. This position secures optimal fee for service and
value-based reimbursement, protects the interests of the owned
and/or affiliated hospitals/ancillaries/professional provider
entities in contract negotiations, and strengthens CommonSpirit
Health’s relationships with payers. Key Responsibilities 1.
Participates in the development of regional strategy,
relationships, and contracts with local and national payers to
further drive a clear and effective negotiation strategy,
reimbursement structure, contract renewal planning process, and
contract implementation. Budgeted and forecasted performance and
growth requirements as set forth by national and regional senior
leaders are integral to these processes. 2. Gathers information and
guidance from Regional PSR VP, ministry leaders, internal
stakeholders, and financial analysis relative to the strategic,
operational, financial needs and expectations of the CA Region
related to the National Payers; proactively communicates with the
PSR National Payer teams. 3. Establishes, builds, and maintains
positive, strategic interactions and relationships with payers,
employers, providers, and leaders across the ministry. Maintains
relationships with National Payer contacts with offices in the
region. 4. In collaboration with Regional Leadership and other
PS&R Leadership, develops and executes communication plans and
Payer Negotiation Outlines related to payer relationships,
negotiations, organizational contractual obligations, and
developments in the managed care marketplace including Fee For
Service and Value-Based Agreements in support of CommonSpirit
Health’s Healthier Communities strategy. 5. Makes independent
decisions and/or exercises judgment based upon appropriate
information and objectives. Comprehends and maintains highly
detailed information. Accepts and carries out responsibility for
direction, control, and planning. 6. Stays current with emerging
payer trends, new reimbursement methodologies, state specific
regulatory issues, plan benefits, payer activity, products and
delivery channels including health insurance exchanges, market
competition, etc. 7. Supports the strategic objectives of
CommonSpirit Health’s IDNs, population health, and care management
initiatives through directly engaging local payers and employer
customers, including CSH employee health benefits. 8. Participates
in and contributes to CommonSpirit Health’s PSR knowledge base
through sharing best practices, developing contract performance
goals, key metrics, new analytical tools, network development,
reimbursement and language guidelines, revenue realization, and
other applicable work streams. 9. Represents Physician Enterprise
entities in Provider Excess bidding process with broker each year
to analyze and establish appropriate coverage for each market
population. This is done along with other Directors representing
hospital interests. 10. Participates in the dispute resolution and
denials processes with local payers if the materiality exceeds $1M.
Participates in joint operating committees and denial committees
for Physician Enterprise as needed. 11. Leads and organizes
sub-projects necessary to support local and national payer
negotiations and growth. Qualifications Education and Experience: •
Bachelor’s Degree – equivalent education and experience in payer
strategy, managed care or provider network senior level role may be
considered in lieu of degree • Minimum of five (5) years of recent
experience in the managed care industry with responsibility for
strategy and negotiations. • Minimum of four (4) years of
leadership and supervisory experience Required Minimum Knowledge,
Skills, Abilities, Training • Working knowledge of provider and
payer industry. • Strength in assessing problems and implementing
solutions. • Significant knowledge of contractual, administrative,
health insurance and operational issues related to managed care
organizations, physician groups, hospitals and health insurance
benefit plan designs. • Proven and extensive technical skills,
negotiation skills, contract preparation and implementation,
financial analysis and rate proposal development, and in-depth
knowledge of various reimbursement methodologies for both fee for
service and value-based contracts, including capitation and various
incentive programs. • Demonstrated ability to set and maintain
multiple priorities in an environment with shifting priorities,
while providing accurate deliverables in a timely fashion. •
Strength in self-motivation and ability to assume ownership of
assignments and projects. Driven to succeed. • Strong
interpersonal, verbal, and writing skills in dealing with payers,
guests and team members.
Keywords: , Chico , Region Director Payer Strategy, Healthcare , Rancho Cordova, California