Providence Health & Services VP - Payer Strategy, California in Irvine, California
Providence is calling a VP of Payer Strategy for our California Service area.
The VP, Payor Strategy for California is responsible for working with the regional teams to drive contracting strategy, negotiation, execution, alignment, and renewal of all contracts with payers for Providence California. These contracts create the source of all Commercial, Medicare Advantage, Direct to Employer, and Managed Medicaid revenue for the entire state.
Reporting to the President, Population Health with accountability to the Chief Financial Officers in Southern California and Northern California as well as the Chief Strategy Officer, Southern Regions, this position is responsible for developing new products with payers, high performance narrow or tiered networks, incentive arrangements and other opportunities that deliver financial sustainability, growth, and competitive advantage in the market. This position helps drive payor contracting decisions in a proactive, creative, data-driven manner and is responsible for coordinating the planning, analysis, and implementation of payer agreements.
The VP serves in a leadership capacity on a team that works together to design and implement strategies for growing the managed care portfolio through price and volume, expanding risk agreements, and developing alternative payment methodologies to meet goals.
This leader establishes influential relationships and creates alignment between Providence and external payers to drive growth and financial sustainability.
The Vice President - Payor Strategy will:
Provide leadership to a team of professionals responsible for analyzing and negotiating over $5 billion in payer contracts annually.
Develop and lead a proactive team that executes on the system and region annual contract margin requirements and movement towards incentive-based payment systems in a responsible manner.
Develop a pathway with payer partners that help the California markets achieve financial sustainability and payor mix balance
Represent contracting as the accountable contracting leader for California and serve as contract and risk contract expert at various forums in the region and system.
Lead strategic planning with regional leadership, establishing and executing on payer specific direction and initiatives
Develop and maintain strong relationships and partnerships with key payers to advance strategic goals.
Partner with Clinical Institutes, Ambulatory Care Network, and Physician enterprise to optimize contracts in line with strategic goals of the region and system such as building Centers of Excellence and value-based PPO contracts
Develop and communicate contract strategies to regional and Executive system leadership.
Design and negotiate complex provider-based incentive programs with payers, employers, and other health care distribution channels.
Work with Population Health and regional leadership to ensure clear understanding of all risk and incentive programs and performance requirements, both financial and quality.
Lead contracting teams in setting annual and long terms goals, objectives, and develop appropriate performance standards, metrics and reporting tools related to payer and provider contracts, government & commercial risk sharing and incentive programs.
Lead contract strategy meetings with regional and system executive leadership and drive proactive execution
Collaborate with ACO, value-based care team, medical group’s quality subject matter experts and other teams to develop standards for defining quality metrics and targets within our incentive and risk-based contracts.
Assess, approve, authorize, and sign all payer and provider contracts and incentive-based reimbursement models.
Required qualifications for this position include:
Bachelor’s degree preferably in healthcare administration, finance, business, or related filed
At least 10 years of executive-level health care experience, with a strong focus in finance and population health highly preferred. Healthcare industry experience should include delivery system and health plan experience.
Excellent negotiation skills in intense, high impact situations finding opportunities to develop win-win relationships that meet the revenue requirements of the organization.
Minimum of 10 years’ experience negotiating risk arrangements for the hospital, health plan, and medical group in a capitated (professional risk, dual risk, full risk, and global risk) and non-capitated environment
Significant experience negotiating both high profile provider payer and provider contracts
Deep understanding of HEDIS quality measures and hospital quality measures and incorporation of these measures into contracts.
Significant experience with the various health plan products and the markets for these various products
Experience structuring and negotiating medical group and IPA contracts, including risk share arrangements.
Demonstrated successful leadership skills in people management and program management and execution.
Must possess the ability to develop relationships and navigate conflicting priorities between the regions and the overall system.
Current knowledge of federal and state policy initiatives related to public health, Accountable Care Organizations, Coordinated Care Organizations and other reform initiatives.
Must possess excellent communication and presentation skills including persuasiveness, assertiveness, initiative, and sensitivity with both internal and external payer executive leadership. Ability to present complex financial concepts in a succinct and clear manner.
Must possess the ability to deal with organizational complexities and conflict.
Must be a strategic thinker with ability to understand the impact of developing long-term effective relationships and partnerships.
Ability to work under pressure and remain flexible with conflicting priorities, while still getting things done through creative implementation of the position description.
Management skills necessary to oversee budget development and management.
Demonstrated leadership ability, communications, and interpersonal skills necessary to interact effectively with physicians, management, staff, and external organizations.
Possesses a balanced understanding of the entirety of healthcare and how the components must fit together as the environment evolves.
Possesses outstanding teamwork skills demonstrated by a record of functioning as a high-impact, low-ego leader who thrives in a team setting, motivated by the advancement of the organization, as well as representing a strong role model and mentor to his/her teammates
Establishes strong team relationships, building trust and open communication, experience as member of senior management teams; demonstrated ability to work as peer and colleague to senior operations leaders; credible voice across the organization.
Functions as a “servant leader” with the ability to command credibility and drive outcomes at the highest level.
Preferred qualifications for this position include:
- Master’s Degree in Business Administration (MBA), Health Administration (MHA); or equivalent education strongly preferred
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Leadership
Req ID: 316078