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Recovery Centers of America at King of Prussia

Full-time Position

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Position Overview:
The Vice President Managed Care Payer Strategy is responsible for leading the execution of the payer strategy supporting the RCA objectives for the assigned market. Responsibilities include all aspects of payer negotiations, managing the regional payer pricing portfolio, overseeing the administrative and business relationship with regional plans through the joint operating committee process, and advising leadership on matters related to health plan strategy. Develop strategies for growing the managed care portfolio through price and volume. Develop annual strategic plan for the managed care portfolio. Leads key regional payer negotiations with the goal of growing the payer portfolio, mitigating OON participating status and advancing value-based pricing logic.
Specific Responsibilities:
  • Partners with RCA leadership to develop and execute short and long-range plans, goals and objectives related to payer strategy and the management of the company’s managed care portfolio.
  • Ensure productive relationships between RCA and the payer leadership. Monitor payer related metrics and lead the development of interventions to continually improve.
  • Collaborate cross functionally within RCA to understand key needs with payers.
  • Monitor state and federal legislation related to payment initiatives, policy changes that could impact negotiations with health plans.
  • Assess and review risks and opportunities across the enterprise related to payment reform, bundled payments, value-based payments, etc.
  • Conduct annual reviews of provider contracts.
  • Analyze claim trend data and/or market information needed to support contract negotiations.
  • Review and present financial data, utilization trends and patient mix needed to negotiate and re-negotiate payer contracts.
  • Negotiate contractual and reimbursement terms with market payers utilizing contracting guidelines with respect to third party payer contractual terms, reimbursement, provider enrollment and product participation
  • Maintain knowledge of payer products, enrollment statistics, and trends.
  • Understand and stay abreast of issues and events that may have an impact on business and industry.
  • Identify contracting / payer disputes that may require legal action.
 
Education and Experience:
  • Minimum of 10 years relevant hospital contracting experience required including significant managed care contracting experience with demonstrated ability in the areas of financial analysis, payment methodologies, contract language, negotiation strategy/tactics, relevant regulatory/compliance issues.
  • Bachelor’s degree required; Master’s degree preferred
  • Excellent communication skills, both verbal and written
  • Outstanding negotiation skills
  • Ability to work with people at all levels of the organization
  • Ability to maintain professionalism in difficult and sensitive conversations where stakeholders may disagree
  • Excellent strategic thinking skills
  • Outstanding organizational and analytical skills
  • Knowledge and understanding of financial implications of various contracting structures
  • Demonstrated knowledge of managed care and value-based care principles
  • Knowledge and experience with value-based contracting structures and of contract language
  • Knowledge of different healthcare rate structures and payment methodologies
 
Competencies:
Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manger that provides satisfaction for the customer within the resources that can be made available.
 
Impact and Influence: Works effectively with and through others including those whom there is no formal authority over.
 
Project Management: Coordinates the diverse components of the project by balancing scope, time, cost, and quality.
 
Communication: Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients.
 
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
 
Travel: Travel is primarily local during the business day.

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