• Anywhere

Recovery Centers of America at King of Prussia

Full-time Position


* Assist in developing strategy to advance strategic partnerships, new care delivery/service reimbursement models, value-based agreement strategy and growth, and overall efforts to maximize the value of strategic payer partnerships for the patient, payer and RCA.
* Lead, manage, mentor and develop Payer Relations team members that are assigned to their region.
* Assess readiness for value-based contracting and outline keys for success.
* Utilize advanced data analytics to package all fees into one value-based bundle, resulting in lower costs to payors, health systems, employers and patients.
* Achieve provider and payer goals through contract arrangements to ensure successful value-based relationship.
* Manage financial risks and data-sharing challenges in risk-bearing reimbursement models.
* Optimize strategies to achieve positive financial and clinical outcomes through specialty bundles.
* Engages in cross-functional initiatives to drive integration and alignment across RCA to improve operational and financial performance.
* Evaluates innovative payer partnership opportunities to ensure alignment with RCA’s strategies.
* Develops, implements and monitors success of innovative national and local payer partnership strategies to drive sustainable financial performance.
* Participates in the designs and implementation of reimbursement strategies for new services/care delivery models to optimize revenue and margin (telehealth, hospital at home, etc.)
* Collaborates with System and Division Finance, Legal, Business Development and Network Operations areas to advance alignment and accountability in order to maximize the value of payer contracts for the patient, payer and RCA.
* Monitor emerging payer trends, new reimbursement methodologies, payer activity, products and delivery channels.
* Travel as needed to support initiatives and operations.
* A bachelor’s degree is required; a master’s degree in business or healthcare administration is strongly preferred
* 15+ years industry experience in managed care within a payor or health care provider organization.
* Must have 8-10 years of progressive experience in healthcare business development and selling to payers and/or providers.
* 10+ years progressive leadership responsibility and experience in healthcare organizations
* 8-10 years strategic management of healthcare pricing, contract negotiation and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment
* Experience working with both provider and payer organizations is preferred
* Experience in value-based reimbursement model development
* Demonstrated success in leading, implementing and managing financial performance of payer contracts.
* Advanced Negotiation Skills