Senior Director Network Contracting - Capital Blue Cross

Position Description:

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

The Senior Director Network Contracting is Responsible for the oversight of all contract related activities within the Healthcare Delivery enterprise, including development and implementation of new risk based agreements in addition to the alignment of legacy provider fee-for-service contracts in support of risk based agreements.

Responsibilities and Qualifications:

• Demonstrate and provide leadership capabilities in the development and implementation of “best practice/risk based” alternate payment models in support of clinical programs to more closely align performance-based incentive models between Capital and its facility and professional contracts.
• Demonstrate and provide leadership capabilities to develop and deploy complex contracting activities through multiple reimbursement methodologies and to meet or exceed budgetary goals. Maintains a positive relationship with all external stakeholders to ensure key contracting objectives can be met. Ensure the negotiation of all key terms of contractual arrangements within key timeframes required to maintain contractual relationship.
• Lead, manages, and oversees complex special projects effecting network and providers such as, reimbursement policies, mass contracting efforts, and vendor strategies that support multiple cross-functional goals and objectives.
• Work collaboratively with peers in developing annual budget targets in support of company goals; actively participate in developing cost of care initiatives to better align Capital to the market in managing the pursuit of more cost effective means to manage the delivery of care while also driving better quality and member satisfaction.
• Lead and manage the contracting department staff. Develop staffing models to support fit-for-excellence mindset. Create professional development, coaching, and performance improvement plans for staff to foster a positive culture and effective unit of skilled staff.

Skills:

• Must be able to lead and motivate individuals and organization within an ever-changing environment. Demonstrated character, competence, and courage to have the social influence in which they can enlist the aid and support of others in the accomplishment of departmental and corporate objectives. Builds and maintains valuable business relationships in fast-paced environment
• Strong analytic and conceptual skills to develop new analytic and financial models. Strong decision making, problem solving, and customer presentation skills (verbal and written). Ability to analyze complex problems and issues, determine impact, and develop business solutions or recommendations for changes.

Knowledge:

• Knowledge of current and emerging reimbursement and alternate payment models, to include governmental reimbursement methodologies. Understands contractual language and necessary provisions to support corporate goals.
• Knowledgeable of various State and Federal licensing requirements and bodies; and existing accreditation organizations (Joint Commission, CARF etc.).
• Ability to quickly gain knowledge of new business processes and issues.

Experience:

• Minimum five years of successful management experience in either a health plan or large health system
• Minimum of seven years negotiating provider agreements.
• Extensive experience developing, negotiating, and managing risk based (ACO, MLR, Partial and Global Risk) agreements required.

Education and Certifications:

• Minimum requirements include a Bachelor’s Degree in a health related field. Master degree highly preferred.

Work Environment:

• Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions.
• Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions, with travel expected.

Location: 

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays. 

 

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

Other:

• Amount (10% of time) local service area (21 county)
• Must possess a valid PA driver’s license to travel to and from i.e., providers and employer groups/plan sponsors locations.
• Key Interfaces: Facets, Tableau, and proficient using Microsoft Office Suite of products (such as Word, Access, Excel, Power Point, Outlook, etc.), Microsoft Project and Visio.
• Oversee provider contracting forecasting budget.
• Oversee all contracting departmental budget related activities for unit including staffing.

 

About Us:We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.    And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.