At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job TitleDirector of Payer Contracting - Ambulatory, Transplant and Ancillary Services

                        

LocationCleveland

                    

FacilityRemote Location

                     

DepartmentMarket and Network Services MNS-Finance

                      

Job CodeT97574

                     

ShiftDays

                       

Schedule8:00am-5:00pm

                       

Job Summary

                         

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

The Director of Payer Contracting – Ambulatory, Transplant, and Ancillary Services leads national payer contracting and network growth for ASCs, Transplant and Gene Therapy programs and Ancillary Services. In this position, you will partner with cross functional teams including pricing, managed care, operations, analytics, finance, joint venture and physician partners and clinical leadership to align contracts with financial goals and care delivery models. This candidate will drive value-based payment initiatives, oversee payer relationships, ensure compliance and lead a high performing contracting team.

A caregiver in this role works remotely from 8:00 a.m. – 5:00 p.m.

Candidates for this position are preferred to reside in Ohio, Nevada, or Florida.

A caregiver who excels in this role will:

Partner with internal stakeholders and joint venture partners to identify growth opportunities and expand the clinically integrated network.

Lead the development of business plans and product strategies to support population health, risk capture, ASC, Transplant, Gene Therapy and Ancillary Service expansion.

Seek new market opportunities in OH, FL, NV and elsewhere to expand payer and provider relationships through innovative contracting solutions.               

Ensure contract operationalization in partnership with revenue cycle, finance, joint venture teams and clinical institutes.

Develop tools and workflows for efficient contract modeling, performance tracking and implementation.

Manage the communication and approval process for new and renew contracts, including reporting to Sr. Director - Payer Contracting, Executive Leadership and Joint Venture Boards.                                                                                

Cultivate and maintain strong payer relationships to facilitate favorable negotiations and long-term partnership success.

Communicate complex contractual elements and ensure alignment with internal revenue cycle and clinical operations.

Identify and escalate payer issues with appropriate internal stakeholders.

Lead the ASC, Transplant, Gene Therapy and Ancillary Contracting team, ensuring appropriate delegation of responsibilities, resource utilization and adherence to policies.

Provide leadership coaching, mentoring, guidance and support for team development and performance.

Monitor compliance with contract terms, government regulations and CCF organizational standards.

Minimum qualifications for the ideal future caregiver include:

Bachelor’s degree in healthcare administration, Business, Finance or a related field and ten years of healthcare payer contracting, including ASC's, transplants, ancillary services, or multi-specialty practice settings

Seven years of leadership or management role within a healthcare system or contracting department

Deep understanding of healthcare payer markets, reimbursement models, provider network structures, joint venture and physician partner relationships

Strong negotiation, relationship management and conflict resolution skills.

Excellent analytical and financial modeling capabilities

Proficient with Microsoft Office and contract management software

Preferred qualifications for the ideal future caregiver include:

Master’s degree

Ten years proven track record in healthcare strategic planning, managed care negotiations and business development

Seven years of experience with contract modeling, value-based reimbursement and population health strategies.

Two years of experience with joint venture and/or physician partners regarding managed care contracting

Mentor/coaching experience

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/

Physical Requirements:

Ability to communicate and exchange accurate information. 

Ability to perform work in a stationary position for extended periods.

Ability to work with physical records or operate a computer or other office equipment.

In some locations, ability to travel throughout the hospital system.

In some locations ability to move up to 25 lbs.

Personal Protective Equipment:

Follow standard precautions using personal protective equipment as required. 

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities