Region Director Payer Analytics Economics-Mountain

As our Division Director, Payer Analytics & Economics, you will be accountable for critical managed care financial analysis, strategic pricing, and payer contract modeling activities for a substantial payer portfolio within a defined Division, directly impacting organizational financial performance and clinical enterprise transformation.

Every day you will oversee and provide expert analytical and pricing guidance for the evaluation, negotiation, implementation, and maintenance of managed care contracts between our providers and payers. You will also recommend and execute strategies to maximize reimbursement and market share, develop new managed care products aligned with strategic plans, and provide essential education to key stakeholders.

To be successful in this role, you will demonstrate exceptional analytical prowess in managed care finance, strategic negotiation skills, and the ability to navigate complex and sensitive situations effectively. Your contribution to system and local strategy, physician alignment, and employee engagement will be vital, requiring a collaborative approach within the Payer Strategy and Relationships leadership team.

• Manage the labor and operations of the Division Payer Analytics & Economics team(s) including the hiring, orienting, developing and managing of staff.
• Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives.
• Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies.
• Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability.
• Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
• Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.

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Required

• Bachelors Other Business Administration, Accounting, Finance, Healthcare or related field 
• Minimum of eight (8) years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
• Minimum of three (3) years of healthcare or financial leadership experience.
• Managed Care and Healthcare experience strongly preferred

Preferred

• Masters Other Master’s Degree 

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.