Director, Payment Model Evolution
HealthCare Support is actively seeking a Director, Payment Model Evolution to fill an opening with one of the nation’s largest managed care organizations. This is a primarily remote role.
Daily Responsibilities for Director, Payment Model Evolution:
- Develop the strategic framework and roadmap for Enterprise’s payment model evolution and oversee the implementation of the strategy across fee-for-service and value-based payment models.
- Devise strategy and processes for decision-making on build/buy/partner initiatives aimed at accelerating and optimizing payment evolution and scaling glide paths to risk.
- Form and lead a team focused on driving payment model evolution, emphasizing market research, best practices in provider engagement, analytical rigor, testing and evaluation, operational efficiency, and improved financial and clinical outcomes.
- Establish payment models that enhance value across Enterprise’s lines of business, considering both employed and independent network partners, various specialty types, and clinical condition categories.
- Implement new and/or updated payment models and collaborate with operations, clinical, contracting, payment integrity, and analytics teams to ensure program effectiveness, transparency, and reporting accuracy.
- Supervise research projects that shed light on new payment model innovations in design, technology, and execution.
- Evaluate and prioritize existing and new value-based payment model programs to decide which ones to launch, scale, or phase out, considering timing and addressing models with overlapping populations/spend for optimal approach.
- Set enterprise payment model evolution goals and provide progress updates to senior leadership.
- Establish a framework for developing business cases for new and/or updated payment models, with a focus on increasing return on investment from provider payments.
- Work with contracting and provider engagement teams to craft messaging for providers regarding payment evolution, aiming to encourage buy-in, increased engagement, and high performance.
- Oversee the creation of educational materials and internal/external stakeholder training on payment evolution strategies.
- Foster collaboration across departments to ensure that payment services align with the needs of members and the organization.
- Represent the organization at industry conferences, webinars, and other events to position Enterprise to identify and capitalize on emerging trends and opportunities in the market.
Required Qualifications for Director, Payment Model Evolution:
- High School Diploma/GED required
- 10 years of experience in complex environments within healthcare, healthcare consulting or managed care in a leadership role
- 10 years relevant experience in the payor market with a focus on payor-provider partnership development and management
- 5 years provider experience via managed services organization (MSO) or direct employment/consultation with provider groups
- Demonstrated success in developing alternative payment model strategies and implementing within payor-provider partnerships
- 8 years’ experience in health care cost data analysis and technical document writing
- Requires experience leading teams focused on value-oriented payment models
- Proficient in MS Office Suite and navigating internet applications
Benefits for Director, Payment Model Evolution:
- Medical Dental Vision
- PTO & Paid Holidays
- 401K eligibility with employer match
- Other Company Perks Available
Pay Details: $165 – $272k/yr heavily dependent on experience and qualifications | Annual Bonus
Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional consideration, please email a copy of your resume to Adam Sanabria - adam.sanabria@healthcaresupport.com with your phone number, the title of Director, Payment Model Evolution and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
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