The Senior Director of Healthcare Procurement & Contract Strategy is responsible for all managed care contracting and vendor administration (MCVA) activities for the Aurora-based Plan Units. This exciting and important position will work alongside and directly manage a tenured Aurora-based MCVA team, as well as will work with executive leadership and operational management to develop and manage the MCVA’s strategic goals. Vendors include a wide range of managed care partners, including contracted network carriers (especially BCBSIL, Horizon NJ, Tufts, Kaiser Permanente), point solutions (transplant networks, payment integrity), Health Center operators (Premise) and preferred providers/systems (Ascension in Chicago, UPenn in AC).
This director will provide their expertise in innovative contracting which will help us explore new opportunities to increase quality and decrease cost. We are looking for someone who loves to research creative ways to build relationships, create and enhance contracts, and who will take the initiative to research and learn markets that are important to us so they can become a subject matter expert.
The director will shepherd and support the Aurora-based MCVA team that finalizes negotiations; coordinates with internal and external stakeholders to implement contracts; and manages day-to-day contractual relationships with a wide range of managed care partners (contracted network carriers, vendors, and preferred providers).
ESSENTIAL JOB FUNCTIONS AND DUTIES
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Responsible for the strategic direction, planning, and management of managed care vendor contracting and monitoring
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Keeps informed on, negotiates and implements new strategies for innovative managed-care vendor and provider contracting such as direct contracting, risk sharing, narrow networks, and bundled payments, as well as unique contracting methodologies, such as contracts with providers at Health Centers and value-based contracting
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Employs consultants strategically and engages with experts in the field in order to identify opportunities
- Oversees the MCVA staff for the Aurora-based Plans Units as they administer, coordinate, negotiate, execute, implement and monitor all managed-care vendor contracts
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Helps analyze contract performance from utilization, financial, operational and member service standpoints for the Aurora-based Plan Units and collaborates with the Las Vegas-based Hospitality Plan on their activities
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Analyzes problems, identifies, and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions
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Supervises, leads, and delegates work and coaches, mentors, and develops employees
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Recommends hires and promotions, directs, and evaluates employment decisions for all assigned positions
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Assists with developing and coordinating policies and procedures
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Oversees continued employee training requirements, safety, and quality initiatives
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Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct with employees; partners with Healthcare Delivery & MCVA leadership and staff to create a safe and inclusive culture with equitable opportunities for success and career growth.
ESSENTIAL QUALIFICATIONS
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10 – 12 years or more of experience in a healthcare, managed care, or insurance organization
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Excellent understanding of, and experience in leading, contracting efforts of the full range of managed care and healthcare approaches, including innovative models such as risk-sharing arrangements and capitation, as well as more unique and/or direct-provider arrangements
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Working knowledge of current legislative requirements under ACA, COBRA, HIPAA, DOL, etc. as related to health benefits, eligibility, payment, appeals, etc.
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Strong data and financial analysis acumen and experience
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Strong report writing and presentation experience
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Demonstrated strong leadership and interpersonal skills to lead others to achieve results in a team-oriented environment
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Knowledge of and experience working with union, Taft-Hartley Trust Funds or mission-driven non-profit organizations are a plus
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Bachelor's degree in Business, Healthcare Administration, related field or equivalent work experience required (master’s degree preferred)
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15% ~ 25% travel required based on business needs and location relative to MCVA staff
Salary Expectations: The salary range for this position is $153,600 - $195,900. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week).
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Pension, Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
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