Senior Director, Payor Contracting

Job Description

Job Description

Title:  Senior Director, Payor Contracting

Location:  Boston (Hybrid)

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the MassHealth ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide.

As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.

We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

The Senior Director, Payor Contracting will be responsible for the overall development and execution of the organization’s contracting strategy with commercial payors (including Medicare Advantage, DSNP, managed Medicaid, and QHP plans), including the initiation, negotiation, and management of contracting processes.

This role will report directly to the Vice President, FQHC Operational Services and work closely with the Chief Business Officer and members of the C3 Leadership Team, particularly the Finance team. The Senior Director in this role will have the opportunity to play a critical role in a mission driven integrated network in its early stages and provide critical input on the implementation and design of its payor and vendor contracts.

Sr. Director, Payor Contracting Responsibilities:

• Responsible Lead on developing a cohesive, data-informed strategy for C3’s payor contracting, including: a prioritization of payors and products to pursue contracts with; term sheets to structure negotiation and ensure contracts are in line with C3’s principles and strategic objectives; processes for coordinating network, value-based and other contracting efforts with payors as well as with C3’s FQHCs; etc
• Lead and manage the execution of this strategy and all payor contracting negotiations, including: outreaching and engaging with payors; establishing contracting timelines and structure and cadence for working meetings; coordinating with C3 teams such as Finance, Quality, Community Technology Cooperative, or Clinical to consult, resolve questions or concerns raised during the contracting process and ensure buy-in on key terms; coordinating the final sign-off process within C3, at the FQHCs as-needed, and at the payors; etc
• Oversee the organization’s payor relations function, including provider data collection and management (e.g. for credentialing); meeting with C3’s teams and payors to review performance on value-based terms; and coordinating any communication between internal stakeholders, FQHCs and the payors
• Other duties as assigned including providing support with vendor negotiations and contracting for development of our shared services

Required Skills:

• Understanding of payor contracting and fee structures on behalf of integrated networks
• Excellent verbal and written communication skills
• Proficient in Microsoft Office Suite or related software
• Excellent ability to conceptualize long-term business goals and develop orderly processes to accomplish those goals
• Excellent managerial and analytical skills
• High attention to detail

Desired Other Skills:

• Experience with a dual eligible special needs plan is preferred
• Familiarity with Federally Qualified Health Centers
• Familiarity with MassHealth ACO Program
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred
• Consulting experience is highly preferred
• Bi/multi-lingual candidates highly preferred
• Project-management skills preferred (not required)

Qualifications:

• Bachelor’s degree; ideal candidate has a Master’s or other advanced degree in Public Health, Public Administration, Business Administration, or another concentration relevant to this role
• At least 5 years of health care experience, inclusive of Medicaid, Medicare, and/ or health plan administration. The ideal candidate has direct experience working at government and/ or at a health plan and/or integrated provider system, working on similar responsibilities
• At least 3 years of experience in contracting on behalf of a health plan or integrated provider system, ideally including experience with Medicare and Medicaid regulations related to contracting and provider networks
• At least 3 years of managerial and/or leadership experience

** In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **