Senior Director – Payer Contracting

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👔 Director

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Cleveland Clinic

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Cleveland Clinic is a not-for-profit, multispecialty academic medical center located in Cleveland, Ohio. Founded in 1921, it integrates clinical and hospital care with research and education, earning a reputation as one of the largest and most respected hospitals in the country. The health system includes multiple facilities across Northeast Ohio and other locations globally, providing a wide range of specialized services such as cancer care, women's health, dermatology, and cardiovascular care. Cleveland Clinic is accredited by The Joint Commission, which underscores its commitment to high standards in healthcare delivery.

📋 Description

• Develop and execute payer strategies reflecting market position, financial goals, reimbursement priorities, growth objectives, and organizational risk tolerance • Lead high-stakes negotiations and renegotiations with market and national health plans across fee-for-service and advanced value-based arrangements • Structure and negotiate shared-savings, downside-risk, percent-of-premium, full-risk, transplant, high-cost drug, and provider-payer product agreements • Own the contracting life cycle from strategy and modeling through negotiation, implementation, performance monitoring, renewal, and escalation • Build analytic frameworks evaluating reimbursement, contract yield, utilization, total cost of care, quality performance, attribution, risk adjustment, and financial exposure • Lead, coach, and develop contracting professionals and analysts • Influence clinical, financial, legal, operational, and executive stakeholders to resolve competing priorities and achieve enterprise-wide outcomes • Strengthen payer accountability and executive relationships while identifying opportunities for market growth and innovative partnerships • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in business, marketing, or health care related field • Ten years of managed care experience in a payer or provider organization • Five years of advanced value-based care or risk-based percent of premium management and negotiating experience in a payer or provider setting • Demonstrated success leading complex payer negotiations with significant financial, operational, and market implications • Deep knowledge of reimbursement methodologies, contract analytics, value-based payment models, risk structures, managed care policy, and relevant legal and regulatory considerations • Proven ability to lead teams and influence senior stakeholders in fluid, highly matrixed environments • 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. • Follow standard precautions using personal protective equipment as required for procedures • Employment offers are followed by testing for controlled substances • Must comply with Cleveland Clinic Health System's influenza prevention program, including annual vaccination or an approved exemption

🏖️ Benefits

• Annual influenza vaccination or approved exemption under the influenza prevention program • Drug-free work environment • Equal employment opportunity