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Fresenius Medical Care · 1 day ago

Director: Payor Relations & Contract Performance

Franklin, TN

Full-time, Contract

Hybrid

Director/Executive

6+ years exp

Fresenius Medical Care is a healthcare company focused on providing high-quality services, and they are seeking a Director of Payor Relations & Contract Performance. The role involves overseeing managed health care programs, managing contractual relationships with payors, and providing strategic leadership to enhance organizational performance and relationships with payor partners.

BiotechnologyHealth CareMedical Device

Responsibilities

Provide strategic leadership of short- and long-term goals through the use of thoughtful techniques in the communication of the company's mission and core values as a means to implement positive change and/or create organizational structure within the assigned business unit(s)

Lead operational efforts through subordinates to complete the administration of business processes and services to ensure the operations effective achievement of goals within the assigned business unit(s)

Direct and control the broad activities of the business unit(s) through the interpretation, application and implementation of company-wide policies and processes appropriate to the functional area(s)

Provide leadership, guidance and coaching for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters

Collaborate with employees in the establishment of clear and concise development plans to ensure succession planning and the advancement of future leaders within the organization

Technically proficient leader in the specific department and knowledge of industry practice and business principles. Has a large range within a department or multiple departments

A strong tactical decision-maker; role primarily focuses on tactical execution. Handles unforeseen issues

Works on complex issues where analysis of situations or data requires an in-depth knowledge of organizational objectives. Has significant program or project responsibility generally within the function

Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results

Decisions have an extended impact on work processes and outcomes. Erroneous decisions will result in critical delay(s) in schedules and/or unit operations, and may jeopardize overall business activities

Requires the ability to change the thinking of, or gain acceptance from, others in sensitive situations, without damage to the relationship. Regularly interacts with senior management or executive levels on matters concerning several functional areas, divisions, and/or customers

Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution. Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations

Provide strategic insight on complex industry issues and lead critical initiatives across Fresenius and the payor community

Identify, analyze and interpret key industry trends to identify strategic growth opportunities, provide strategic recommendations and negotiate with payor partners

Develop and maintain strategic relationships with a multitude of payors including PBMs, Health Plans, Regional Health Plans, Government Payors and other large payors

Oversees contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per FMCNA guidelines, and contract maintenance such as facility list updates and amendments

Develop and foster strong, positive working relationships with existing and future payors to maximize opportunities and promote the company's value proposition

Negotiates contractual relationships with managed care organizations and other third party payors, as needed

Requests or approves in-depth amendments to or extensions of contracts

Researches, maintains, and updates payor contracts for assigned accounts

Serve as subject matter expert on complex insurance and payor related activities with the management and executive teams

Recommends strategies to improve overall performance, quality of service, and suggests changes in working conditions to increase efficiency

Presents high level contract proposals and market and industry analyses to internal parties and responds to requests for proposals from third party payors

Lead complex negotiations, align operating and strategic activities and processes

Reviews and analyzes complex potential contracts for financial effect, cost benefit, and utilization

Develop, implement, and manage various programs that enhance payor partnerships, grow Fresenius share and profitability. Programs include but not limited to preferred networks, MTM, value based reimbursement, etc

Assist with and maintain a permanent record of all major payor contract negations. Once a contract is negotiated, assist in administering implementation protocols to ensure a smooth and timely operationalizing of the contract

Maintains existing contracts and implements new contracts, serving as the primary point of contact for state and regional plans

Ensures all contracts and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced

Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations

Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance

Provide technical guidance

Assist with various projects as assigned

Other duties as assigned

Qualification

Contract negotiationPayor relationsStrategic leadershipManagement experienceOperational experienceBusiness analysisDatabase managementBusiness computer systemsInterpersonal skillsCommunication skillsTeam leadership