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SENIOR ADVISOR, PAYER STRATEGY
Job Title: SENIOR ADVISOR, PAYER STRATEGY
Job Code: 5562
FLSA: E
Job Level: L2
Revised Date: 03/01/2017
Supervisory Responsibility:
General Description of the Job Class
On behalf of Duke University Health System and the Senior Advisor is responsible for payer strategy, value-based purchasing capabilities, and program of distinction/national payer and employer outreach and contracting efforts. In collaboration with the AVP for managed care, the Senior Advisor will pursue negotiations for ACO contracts and other innovative payer arrangements consistent with current and emerging reform opportunities. The Senior Advisor will lead development of payer strategy and discussions on managed care contracting innovation, future directions and needed coordination with the clinical community. The Senior Advisor will maintain a close working relationship with the Senior VP/CFO and Treasurer in the development, prioritization and implementation of strategy essential to future growth and competiveness.
In addition, the Senior Advisor will develop mechanisms to monitor relevant policy at a state and national level and assess opportunities and threats related to emerging and evolving issues. He/she will work closely clinical leadership, marketing, development and contracting to identify and pursue volume and financial opportunities related to Duke Medicine???s Programs of Distinction (POD), national payer and direct employer contracts for targeted services.
The Senior Advisor will ensure strategy execution through contracting activities, including ever-changing relationships and reimbursement structures with payers. In this role, the Senior Advisor will interact with executives throughout DUHS as well as managed care payer executives and provider partner executives.
Duties and Responsibilities of this Level
- Develop annual and multi-year payer strategic plans aligned with changing health reform landscape.
- Assure that such plans align with the Health System???s overall strategic direction and mission statement.
- Provide input to senior management relative to business development and strategic positioning as it relates to payer strategy.
- Serves as DUHS??? chief strategy liaison to the payer community.
- Pursue and develops relationships with payers and large national employers with regard to health reform and new payment models.
- Develop effective and long-lasting communication channels with them.
- Act as DUHS expert on emerging payer/health reform trends nationally and regionally.
- Support DUHS growth initiatives by leading efforts network development, value-based contracting and other major efforts associated with developing the clinically integrated network. Be an effective partner to CIN physician leaders.
- Lead development of innovative arrangements with national payers, large employers and embassies for Duke Medicine???s programs of distinction to bring increased volume and revenue to Duke.
- Act as internal consultant and educator on health reform related issues to Health System executive leadership; establish routine cedule for briefing Chancellor???s Cabinet and/or Executive Management Committee on developments of importance.
- Working with Planning and Finance, develop effective models for developing scenarios to evaluate the potential impact of various reimbursement related changes on the organization.
- Lead development of national employers/payers. Assure that federal and state policy related to health reform is closely monitored. Identify opportunities arising from emerging policy that impacts the organization. Serve as primary resource to members of DUHS senior and executive management regarding impact of health reform/payer strategy???s on proposed operational initiatives.
- Build processes for decision-making to include active involvement of all relevant stakeholders; provide leadership through consensus building.
- Obtain and maintain up-to-date information and knowledge of managed care/payer environment, including but not limited to local, state, and national developments and their potential impact on DUHS. Develop and maintain relationships with appropriate agencies.
- Develop and maintain network of relationships with people at other integrated health systems who are responsible for payer strategy.
- Serve as a key strategist in preparing DUHS for the changes in healthcare reform including Accountable Care, Clinically Integrated Networks, Patient Centered Medical Home, etc. to ensure the Health System is well positioned to benefit from the changes in reimbursement from the payers.
- Lead, mentor and develop staff and members of the Planning and Network Services team.
Required Qualifications at this Level
Education
Bachelor's degree required. Master's degree in Business, Finance, Hospital Administration, or related field is preferred.
Experience
Work requires fifteen years of progressive leadership experience, payer strategy and or managed are contracting experience and exposure to managed care payers at the senior level. Successful past experience managing complex change initiatives within the managed care function. Individual will have directly negotiated provider contracts and will have strong financial acumen and a comprehensive understanding of health reform contractual options, healthcare economics and competitors' practices. Will have a deep knowledge of how contacting relates to medical costs, the delivery of high quality healthcare and a thorough understanding of proposed changes that healthcare reform will have on hospitals and integrated systems.
Degrees, Licensure, and/or Certification
Knowledge, Skills, and Abilities
The individual for this position will have strong communication skills and a proven track record of managing relationships well, both internally and externally. Will be comfortable working in a collaborative and consensus building environment and have the ability to work with diverse constituents. The Senior Advisor must have vision, initiative, stamina, intelligence, assertiveness, strong impersonal skills, and a results orientation. Must be strategic and able to see the big picture as well as have a strong detail orientation. The ability to achieve financial and business objectives is critical.
Distinguishing Characteristics of this Level
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
