Provider Contracting Director jobs in Buffalo, NY

Company :

Job Description : 

JOB SUMMARY

This job is responsible for the day to day interactions with the Organization's integrated delivery system partners in the Buffalo NY market. The incumbent has the primary responsibility for the development and execution of a multi-year post-affiliation/partnership integration strategic plan in support of the Organization's investments in integrated provider partnerships.  Interfaces directly with provider partner executives and operational teams to actively represent the Organization and their interests in the partnership.  Works closely across all aspects of the Organization's business units including the product, provider network, provider relations, sales, operations, reimbursement, analytics and strategy functions and internal steering committees in leading the execution of the partnership. Collaboratively leads the development of new healthcare delivery facilities, including hospitals, ambulatory care centers, and outpatient surgery centers through all phases of ideation, strategic programming, site selection, design, construction management, and go-live readiness.  The incumbent participates directly in physician practice acquisition strategic planning, negotiations, and post-acquisition integration activities in support of the integrated partnership.  Once new provider delivery assets and JV’s are operational, the incumbent engages directly with the operational leadership team of the provider partners to represent the Organization's interest in operating such ventures with a focus towards delivering customer focused  high quality, value based care models in the community.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Partner closely with the partner provider c-suite executive team and established shared governance committees to lead the strategy development and execution of the integrated provider partnership business plan that supports the long-term partnership objectives and overall partnership strategy.
• Develop, execute, and manage the multi-year post-affiliation/partnership business plan and strategy execution in deep collaboration with partner provider team resources and executives.  Lead the Business Development team in the development of the business case, financial modeling, valuation, due diligence, deal structuring and negotiation to deliver executed deals.
• Lead the identification and assessment of strategic integrated provider partnership opportunities to advance the Organization's near- and long-term goals through partnerships, alliances, physician acquisitions, and other business/asset development activities.
• Develop and maintain relationships across a broad sphere of influence within the Organization and integrated provider partners, including internal stakeholders, executives and management teams of our provider partners, independent physician practices, and other external contacts to achieve business development and partnership objectives. Represent the Organization as an integrated payer partner of choice at external meetings, conferences, and industry events.
• Lead cross-functional project deal teams that engage key internal stakeholders and external partners (legal counsel, external experts etc.) to ensure successful partnerships.
• Manage a portfolio of alliances, monitoring the successful execution of our alliances and partnered programs directly.
• Lead impasse resolution and serve as direct contact for partner executives as necessary.
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelors Degree

Substitutions

• 6 years of health plan contracting or provider relations experience in lieu of degree

Preferred

• Master's Degree in Business Administration/Management or Health Administration

EXPERIENCE

Required

• 7 - 10 years in the Healthcare Industry

To Include

• 5 - 7 years in Management
• 3 - 5 years in Business Development or Provider Services

Preferred

• 3 - 5 years in Strategic Planning
• 3 - 5 years in Consulting
• 1 - 3 years in the Health Insurance Industry

LICENSES OR CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Negotiation
• Leadership
• Strategic Thinking
• Innovation
• Mentoring
• Collaboration

Language (other than English)

None

Travel Requirement

None

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position-type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Constantly

Works primarily out-of-the office selling products/services (sales employees)

Frequently

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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