Senior Director, Payor Partnerships in Plantation, Florida at Pediatric Associates

PRIMARY FUNCTION Pediatric Associates Family of Companies is in an exciting phase of growth and investment, calling for a managed care expert to drive the seamless integration of our valued physicians with payor partners at a national scale. The Senior Director of Payor Partnerships will be joining an organization with the deeply held purpose of delivering accessible, compassionate care of highest quality to pediatric patients and their families. The Senior Director of Payor Partnerships will be responsible for developing, maintaining, and managing the integrity of payor relationships across the Pediatric Associates Family of Companies (PAFC). This role will serve as an external-facing PAFC leader in directing strategic payor initiatives to promote positive patient engagement, foster provider experience, and establish PAFC as an industry leader in value-based pediatric care delivery. In addition, the Senior Director will drive payor partnership strategy execution for existing markets and acquired entities, lead contract negotiations, and manage performance oversight spanning the valuebased continuum. Instrumental to these objectives, the Senior Director will ensure leadership level coordination across multiple internal departments in the deliverance of strategic objectives. Reports directly to the SVP of Payor Relationships. ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

1) Provides strategic leadership, direction, and oversight of all payor arrangements executed and managed on behalf of the Pediatric Associates Family of Companies (PAFC). Evaluates the managed care industry landscape to promote evolution and agile adaptation to changes in the competitive landscape for achieving differentiated growth at national scale.

2) Evaluates, negotiates, and secures financially and administratively favorable contracts spanning the value-based continuum with health plans, managed care organizations, state agencies, and community partners. Manages all components of the negotiation process for directly negotiated agreements.

3) Leads a team of Payor Relationship Managers to implement, operationalize, and maintain value-based payor relationships in accordance with the associated engagement framework across PAFC departments. Participates and/or facilitates regular meetings with payors to foster continuing contract performance, identify issues affecting payment or operations, and promote Pediatric Associates’ maximizing the value and effectiveness of payor contract terms.

4) Leads Joint Operations Committee payor meetings and represents PAFC externally as business leader. Produces executive level reports highlighting financial and relational value of payor contracts.

5) Creates payor engagement best practices, processes, accountable monitoring frameworks, and reference tools for cross-functional stakeholder use in managing and monitoring value-based contract partnerships.

6)Obtains, reports on, and monitors the financial, quality, and value-based metrics of all contractual arrangements and leads discussions with payors regarding contract performance, growth, and clinical opportunities. Partners closely with Finance leaders for performance forecasting.

7) Maintains integrity of payor partnerships across all markets. Ensures transparent bi-directional stakeholder communication across multiple stakeholder levels in the identification and remediation of issues or performance trends and quantifies impact to PAFC. Investigates and drives end-to-end resolution of payor issues. Hardwires collaborative best practices for internal stakeholder teams to facilitate payor partner of choice status and deliver exceptional performance.

8) Performs payor-related due diligence activities with regards to prospective acquisition targets; actively manages the contracting and integration of acquired practices.

9) Serves as Subject Matter Expert in managed Medicaid regulations and value-based care operations across all business lines. Educates internal matrix partners about payor processes, revenue cycle impacts, and industry trends impacting the Medicaid and commercial landscape.

10) Coordinates and communicates regularly between Payor Partnerships team, Executive Leadership, and other key stakeholder departments.

11) Performs special projects as requested/all other duties as assigned.

SUPERVISORY RESPONSIBILITIES •

Manages and develops a team of Payor Relationship Managers.

• Heavily matrixed position, requiring influential leadership across stakeholders nationally.

• Provides team with ongoing training, performance feedback, and avenues for professional development.

• Establishes team goals and team performance KPIs.

QUALIFICATIONS

Bachelor’s degree in healthcare or related field required, Masters preferred. Education may alternatively be commensurate with 10 years of directly applicable experience.

• Minimum of 7 years combined payor and provider contracting experience is required.

• Minimum of 5 years management experience spanning a cross-functional and highly matrixed team is strongly preferred.

KNOWLEDGE, SKILLS AND ABILITIES

Extensive understanding of contract language, value-based payment methodologies, and contract performance evaluation spanning Medicaid, IFP and commercial lines of business

• Experience developing, managing, and influencing relationships across a cross-functional matrixed environment

• Superior payor negotiation skills, with specific experience in risk and value-based contracting

• Knowledge of Statewide Medicaid Managed Care programs and Commercial payors

• Strong strategic planning and organizational skills to manage multiple priorities and projects

• Effective communicator to internal and external audiences, including executives, balanced with strong interpersonal skills.

• A team player with experience in complex environments with the ability to build consensus among divergent interests and competing organizational needs.

• Servant leadership mentality

Proficient in research, analysis, and interpretation of financial data and trends

• Advanced Microsoft Office skills

TYPICAL WORKING CONDITIONS

• Non-patient facing

• May be either full-time remote or on site

• Must be U.S. based

• Travel up to 15%

OTHER PHYSICAL REQUIREMENTS • Vision • Sense of sound • Sense of touch PERFORMANCE REQUIREMENTS Adhere to all organizational information security policies and protect all sensitive information, including but not limited to PHI (Protected Health Information) and ePHI, in accordance with organizational policy, federal, state, and local laws and regulations. Comply with all federal, state, and local laws & regulations in the states where the Pediatric Family of Companies operates