Associate Director, Payor Strategy - Value Based Managed Care Contracting

MD Anderson Cancer Center - Houston, TX (30+ days ago)4.1


The primary purpose of the Associate Director, Payor Strategy is to work closely with the Director, Managed Care Contracting in MD Anderson Cancer Center's Financial Clearance Center. The Associate Director, Payor Strategy will assist in developing new reimbursement models across the Organization's markets and business lines. This includes:

Creating a comprehensive suite of reimbursement models that align the strategic objectives across multiple areas within the provider organization

Defining new themes for reimbursement innovation based on a deep understanding of innovation and trends in reimbursement from across the country, with a particular eye on options for responding to changes in both commercial and government reimbursement, including those CMS programs focused on provider innovation

Developing a shared capability and implementation roadmap that is consistent across areas

Consistently updating and infusing the Organization's reimbursement strategy with innovative approaches to achieve return on investment (ROI) and provider alignment; working with finance, and reimbursement operations to build the ROI frameworks of new programs.

The ideal candidate must have experience negotiating value based reimbursement contracts with a managed care organization and/or academic medical center. Seven years of experience are required, including three years of supervisory/management experience.

The University of Texas MD Anderson Cancer Center in Houston is one of the world's most respected centers focused on cancer patient care, research, education and prevention. It was named the nation's No. 1 hospital for cancer care in U.S. News & World Report's 2017 rankings. It is one of only 49 comprehensive cancer centers designated by the National Cancer Institute.

SALARY RANGE

Minimum: $94,800 Midpoint: $118,500 Maximum: $142,200

KEY FUNCTIONS

1. Provide Direction

Assist in development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for health system, Houston Area Locations, and physicians across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs. The Associate Director must work collaboratively with numerous departments within the Finance Division and other Divisions throughout the institution which include Legal Services, Clinical Operations, Research and Governmental Affairs. The Director will serve as the primary contact for all managed care related functions.

2. Contract Negotiation

Work closely with the Director, Managed Care Contracting and others across the institution to support the development of targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation.
Support strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with Director, Managed Care Contracting and key thought leaders.

3. Analyze data
Oversee efforts to analyze and project financial impact of contracts and proposals, by providing in depth assessment of reimbursement methodologies and associated risk, including bundled and value based payments.
Efforts include interpreting and explaining the pros/cons related to proposed payment terms and requirements.
Keep abreast of new developments in both the public and private reimbursement space, including new innovative models developed by CMS to ensure seamless integration and that the organization is ahead of the curve with regard to our strategy.

4. Collaboration
Work with reimbursement and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market.
Work closely with colleagues at MD Anderson and Physician Referral Services (PRS) to support in the development of specific reimbursement models as part of our strategy and as a means to pilot new programs.
Serve as a resource for the institution on issues related to value-based reimbursement, including impact to organizational strategic efforts or new programs in development.

Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners.
Participate in collaborative efforts and provide recommendation related to the annual strategic planning, development and implementation of reimbursement strategies for hospital and physician services.

EDUCATION
Required: Bachelor's degree in Business Administration, Healthcare Administration or related field.
Preferred: Master's degree in Business Administration, Healthcare Administration, Public Health, or other health care related field.

EXPERIENCE
Required: Seven years of related experience in a managed care organization, academic health care provider or public sector, to include three years of supervisory/management experience.
Preferred: Experience in value-based reimbursement through managed care contracting, provider reimbursement, consulting, population health delivery or related areas. Experience in an academic medical center and/or Managed Care organization. Familiarity with managed care relationships, care transitions, and payment models.

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html