Job Req ID: 152105

Position Number: 00162488

Employment Type: Full Time

Shift: Variable/On Call

Shift Details:

Standard Hours: 40.00

Department Name: Contracting & Payor Relations

Location: CHS Corporate Operations

Location Details:

Job Summary

This position will reside in Charleston and work closely with Roper St. Francis Health System (RSFH) Leadership as a liaison between RSFH leadership and CHS Managed Health Resources. AVP will report to System Vice President of Payer Contracting and Relations for CHS with a dotted line to CFO of RSFH. AVP will be responsible for setting the contracting strategy and ensuring execution of the strategy by either cooperating with the MHR contracting team in Charlotte or directly negotiating the contracts. AVP will ensure effective communication of payer contracting activities between RSFH leadership teams and MHR.

Essential Functions

• Leads team to meet objectives of MHR and the System.
• Ensures appropriate negotiation planning is completed and presented.
• Develops strategy to support the growth of the System through meeting the critical needs of owned and managed facilities, providers and ancillaries.
• Ensures appropriate contract rates and language be negotiated within established deadlines with financial results that meets or exceeds net revenue budgets and net margin targets to support the mission of the System.
• Provides the System with accurate and current managed care market intelligence; maintains a working understanding of local/regional/national trends, conducts competitive market assessments, changes and impact of regulatory environment, changes and impact of payor initiatives and provides other information to support MHR and the System initiatives.
• Ensure Managed Care Analytics team members accurately and timely completes all required analyzes and contract modeling to support Managed Care strategies and operations.
• Oversees the development and delivery of standard contract metrics, reporting frequency, and delivery of Executive Summary report to measure portfolio performance.

Physical Requirements

Performs most work under normal office conditions. May include sitting for long periods, standing, driving, walking. Intact sight and hearing with or without assistive devices required. Require frequent verbal and written communications in English to payors, teammates, physicians, and others throughout the System.

Education, Experience and Certifications

Masters Degree required (MBA or MHA); will consider Bachelors Degree with experience in a comparable position within a like size or larger organization. Ten (10) years provider experience, as a contract negotiator, or in a financial management or analysis role required; willing to consider 12 years combined provider and/or payor experience as a contract negotiator or in a role in financial management or analysis. Experience with a major payor/major system required; experience with multi-system and/or large physician multi-specialty group preferred. Experience with value based reimbursement methodologies is valued.

At Carolinas HealthCare System, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.

As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.

Posting Notes: Not Applicable

Carolinas HealthCare System is an EOE/AA Employer