What are the responsibilities and job description for the Senior Contractor Value Based position at Priority Health?
This is a hybrid position. The onsite requirements for this position are 2 or more days per week onsite.
Job Summary
With minimal direction, acts as the key contact and subject matter expert for all value-based contract-related activities. This includes developing and negotiating contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. This position must have experience in valued-based models, including but not limited to shared risk arrangements, bundled payments, pay-for-performance, and capitation. Analyzes and evaluates change to drive continuous improvement in the process of value-based program development, contract management and contract management trends. Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position manages the contract execution process, resolving problems, mitigating delays, mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of value-based contracts and providers. Regularly provides guidance and training to less experienced Specialists.
Essential Functions
Required
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Beaumont Service Center - 26901 Beaumont Blvd
Department Name
PH - Provider Contracting
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. - 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Job Summary
With minimal direction, acts as the key contact and subject matter expert for all value-based contract-related activities. This includes developing and negotiating contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. This position must have experience in valued-based models, including but not limited to shared risk arrangements, bundled payments, pay-for-performance, and capitation. Analyzes and evaluates change to drive continuous improvement in the process of value-based program development, contract management and contract management trends. Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position manages the contract execution process, resolving problems, mitigating delays, mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of value-based contracts and providers. Regularly provides guidance and training to less experienced Specialists.
Essential Functions
- Manage the value-based contract development and negotiations process for provider networks initiatives. Enters/maintains current information in the internal contract repository and system contract database.
- Create value-based contracting strategies and deploy strategies to move providers to desired contract terms according to program guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.
- Act as the principal contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.
- Interface routinely with hospital, PHO, and PO leadership on an independent basis while understanding other political sensitivities of assigned groups.
- Work with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, value-based methodologies. Facilitate contract implementation process with the appropriate teams. Work collaboratively with applicable internal teams to find solutions to provider issues concerning payment, reports and operation procedures, etc, when necessary.
- Creates a customer-focused, service-based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.
- May represent contracting at external and Joint Operating Committee meetings. May be requested to present and represent Value-Based Contracting at meeting with external constituencies.
- Provides mentoring to less experienced team members and is accountable as a role model for customer service excellence.
Required
- Bachelor's Degree or equivalent in business administration, health care administration, psychology, finance, or health and human services
- 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either third party payers or health care providers
- 7 years of proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations
- Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies
- Master's Degree in business administration, health care administration, finance, or health and human services
- 3 years of relevant experience, negotiating and managing valued-based contract lifecycles on behalf of either third party payers or health care providers
- Experience working with legal staff
- Skills in best practices for contract negotiation tactics and strategies
- Working knowledge of anti-trust laws
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Beaumont Service Center - 26901 Beaumont Blvd
Department Name
PH - Provider Contracting
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. - 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
