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Director Provider Contracting

Boise, ID, USA | Cambia

  • Industry:
    Healthcare - Health & Life Insurance
  • Position Type:
  • Functions:
    Business Development
  • Experience:
    10-12 years
Job Description:
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At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.

Achieving our ambitious Cause requires exemplary leadership. In addition to the Cambia values listed above, our leaders demonstrate the following leadership attributes: Cambia leaders think big, push boundaries, envision possibilities, inspire and empower others. They build collaborative relationships beyond their functional area and create workplaces which are just and transparent. Our leaders must be lifelong learners, develop others and act as role models for their teams, colleagues, external partners and—most importantly—our current and future members.

Responsibilities & Requirements

The Director leads the provider network strategy and contracting team for the state of Idaho..Directs the implementation of the network strategy through contracting, negotiation, and administration of provider and facility agreements for physicians, physician groups, healthcare institutions and ancillary services. Cultivates and maintains relationships with key providers and promotes innovative products and reimbursement methodologies.

Role Responsibilies:

Leads the state-wide contracting strategy efforts and partners with leaders across the organization to ensure alignment with broader business strategies and key initiatives.

Ensures contracting staff develops strong partnerships across the provider community and promotes positive working relationships with all types of Regence providers including physicians, physician groups, ancillary specialty providers, hospitals, institutions, etc.

Collaborates with the Actuarial Team to ensure analytical resources effectively support contracting efforts and pricing considerations. Ensures provider feedback, competitive information, health care delivery trends and other metrics are incorporated into contracting strategies and financial models.

Manages the contracting team including hiring, performance management, development and retention.

Develops strategies along with Vice President of Network Management to ensure unit cost targets and cost stewardship goals are met. Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure individual and team deliverables are met.

Directs execution of contracting and reimbursement strategy and ensures contractual methodology is in accordance with organization objectives, legal, and regulatory requirements.

May manage related functions, strategic initiatives, and/or best practice development.

Provides support (within and outside the organization) when the VP of Network Management is unavailable.

Supervises 2 FTEs.

Minimum Requirements:

Director Provider Contracting would have a Bachelor’s Degree in healthcare, business or a related field (Masters preferred), 10 years’ experience in healthcare provider contracting, 3 years leading others, or equivalent combination of education and experience.

Demonstrated success in negotiating contracts and managing relationships with large, complex hospitals, provider groups, and integrated delivery systems.

Strong understanding of managed care and accountable health systems models and relationships to contracting strategy and reimbursement methodology.

Analytical expertise and ability to interpret complex data for effective decision making. Includes understanding and competency related to health care funding mechanisms, quality and utilization data.

Strong communication and facilitation skills with all levels of leadership, including the ability to identify and resolve issues and build consensus among groups of diverse stakeholders.

Ability to develop and lead a team including: hiring, goal setting, coaching and development.

Demonstrated competency in resource and project management: budgeting, organizing work, providing leadership to staff, establishing measures for success, and managing to deliverables.

Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity.

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