Payor Contracting Strategy Lead - Careallies - Remote

Role Summary

This position has overall accountability for managing the CareAllies’ payor contracting business advisory services related to contracting governance and payor contract negotiations. This role has accountability for executing using CareAllies’ Payor Contracting Standards, compliance and oversight and results in the affordability, patient retention and growth and clinical and financial performance strategies for itself and its clients. This role partners closely with leadership from key matrix partners to develop and implement the Payor Contracting Standards to support CareAllies’ clients’ medical cost improvement and profitable retention and growth, while doing so within contracting standards.

This position is also responsible for ensuring that the results are delivered within CareAllies’ standard contracting requirements across all payors’ lines of business (Commercial, Medicare, Medicaid, ACA) and products (HMO, POS, EPO, OA, PPO etc.). This position is also responsible for creating and iterating on the standards as they support various affordability, retention, growth, and performance initiatives including working with payor contracting, operations and service line leaders to reduce exceptions to those initiatives. This position is also responsible for payor contracting.

Duties & Responsibilities

• Negotiation of market competitive payer contracts in terms of rates, structure and language.
• Leads the creation, iteration, and application of the CareAllies’ Payor Contracting Standards & Approval requirements for contract negotiators and contract management. Ensures that these Standards do not jeopardize CareAllies’ contracts with clients, internal policies, or standards. Ensures required documentation and analytics are complete prior to review with the client. Facilitates internal and external audit requirements.
• Contributes to and executes the direction and evaluation of CareAllies Contracting.
• At ease with providing consultative input to CareAllies’ clients regarding matters of contract standards.
• Partners closely with leadership from our key matrix partners from Provider Contracting, Operations, Service Line, Medical Economics, etc. in developing and implementing the Contracting Governance supporting medical cost improvement and profitable growth for CareAllies’ clients.
• Ensures members of contracting team receive appropriate and continuous training in all aspects of
  contracting standards, including use of current, appropriate, core contract templates; preferred
  reimbursement standards; contracting policy; and the standard contract process.
• Ensures understanding and compliance by contractors with the standard contract process and review of all exceptions to "ability to administer", financial objectives, policies, and language.
• Provides consultative support to contractors on contracting, policy and procedural issues as needed.
• Collaborates with Operations to identify and implement a contract management system, processes, and templates.
• Supports contracting in maximizing use of system.
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