Job Description
Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Position reports to Vice President, Payer Relations, Yale New Haven Health System. This position is a senior managed care position and responsible for directing and overseeing the health plan contracting, contract implementation and ongoing contract management for the Yale-New Haven Health System Entities (Yale New Haven Hospital, Bridgeport Hospital, Greenwich Hospital, Lawrence & Memorial Hospital and Westerly Hospital along with the non-hospital entities. The position deals with external constituents, including managed care payers, employers, third party administrators and insurance companies, as well as internal constituents within Y-NHH, including the System Business Office, Finance and senior managers of the hospital(s) Contracts are negotiated and coordinated in conjunction with the VP and SVP, Payer Relations.
EEO/AA/Disability/Veteran
Responsibilities
- 1. Negotiates with managed care organizations and/or insurers to obtain provider services agreements that advance the profitable growth of the Yale-New Haven Health System. The majority of the agreements are negotiated directly by incumbent or his/her designee. Several major agreements may be negotiated in conjunction with the VP/SVP, Payer Relations.
- 2. Ensures that provider services agreements can be supported and key deliverables or performance targets upheld in advance of committing the organization to their terms.
- 3. Responsible for delivering critical information concerning covered services, par providers, carve-outs and fee schedules to affected internal clients in a timely manner; facilitates clear and unequivocal communications between contractors and health system clientele as necessary to ensure smooth implementation of agreements.
- 4. Maintains a keen awareness of the external business environment and most-likely prospects for garnering new payer agreements and/or favorable payment provisions.
- 5. Supports the hospital's quality program initiatives and ensures that the relevant standards are upheld in all contracting ventures.
- 6. Cultivates effective partnerships with internal hospital and health system colleagues to present a cohesive and proactive team approach to meeting client needs.
- 7. Position routinely negotiates with senior executives at major health plans and includes hospital, professional, behavioral health, transplant, burn and all other services delivered by the YNHHS.
- 8. Assisting the VP/SVP, Payer Relations with development of overall Health System managed care strategy and assists in the implementation of that strategy.
- 9. Assists the VP/SVP, Payer Relations in the development and implementation of the necessary health care reform initiatives as directed by the Health System Executive Leadership Group.
Qualifications
EDUCATION Bachelors Degree (Masters Preferred) in business, public health, health care administration or related field. EXPERIENCE Minimum of six years contracting experience in progressively responsible management roles within a health care setting. SPECIAL SKILLS - Exceptional communication skills, both verbal and written.
- Solid understanding of managed care, payment approaches, risk and capitation and managed care financial models.
- Excellent negotiation and partnering skills. Ability to make tough decisions with confidence.
- Ability to deal with ambiguity.
- Operational understanding of planning and marketing, finance, business office systems, human resources, hospital operations and medical staff leadership.
- Political savvy, strong ethics and teamwork skills.
YNHHS Requisition ID
135097
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Yale New Haven Health
Oct 22, 2024