Executive Director, Payment Transformation

This is a fully remote position, open to applicants in Illinois, +4 more states.

📋 Description

• Managing enterprise payment transformation initiatives, which encompass payment strategies, model design, implementation of alternative payment models, and comprehensive VBC administration.

• Overseeing VBC strategy, including the creation of new VBC models and the enhancement of existing ones across all Lines of Business, as well as the National Network Strategy and Integration.

• Guiding and expanding Value Based Care provider contracting, along with the development, oversight, and management of competitive provider pricing models, medical economic opportunity analysis, and Performance Based Reimbursement programs.

• Evaluating new network VBC target opportunities and value propositions; designing, governing, and executing VBC strategy.

• Creating, advocating for, and presenting the strengths and advantages of the network.

• Supervising VBC analytics, provider performance reporting, and platforms, as well as all payment administration systems, which include data integration, payment platform delivery, technical releases, year-round operations, audit oversight, and issue resolution.

⛳️ Requirements

• A Bachelor’s degree with 10 years of managed care experience at the health plan level or within a hospital/health system, including direct responsibility for strategic network and financial management operations, or a Master’s Degree with 8 years of experience in healthcare consulting and/or data insights and finance related to healthcare information.

• 7 years of management experience.

• Strong leadership capabilities to guide a team and achieve results through cross-departmental collaboration.

• Familiarity with complex managed care concepts in a matrix management setting.

• Experience in developing solutions and systems that support network development initiatives and Value Based Care programs.

• Expertise and/or proven experience with business intelligence tools, including designing, reporting, and delivering analytical solutions, data management and warehousing, and the strategic application of information.

• Experience in enterprise-wide project coordination, project management, facilitation, presentation, and leadership.

• Proven experience in integrating large, complex multifunctional business systems into operations.

• Experience managing projects with multi-functional team members.

• Ability to interact and influence a diverse range of stakeholders, including providers, regulators, other health plans, members, and staff.

• Knowledge of State and Federal laws and regulations.

• Awareness of trends and innovations in network management.

• Excellent verbal and written communication skills, including strong interpersonal and presentation abilities.

• Experience within the insurance industry, including understanding trends in philosophy, theory, and applications concerning all products and services.

🏝️ Benefits

• Health and wellness benefits

• 401(k) savings plan

• Pension plan

• Paid time off

• Paid parental leave

• Disability insurance

• Supplemental life insurance

• Employee assistance program

• Paid holidays

• Tuition reimbursement

• Other incentives