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Position:

Contracting Solutions Director - Hybrid - St. Louis, Mo

Position Summary:

Executes the network development and value-based contracting strategy for new market(s). Acts as a Subject Matter Expert for provider networks, provider reimbursement models, incentive payment models, and model contract language. Contributes to establishing and providing oversight of the department's policies, procedures, and practices. Negotiates contracts, develops strategies and methodologies, contract terms, and alternatives for all contracts.

Job Description:

Primary Responsibilities

• Accountable for all network contracting needs across the market.
• Informs and optimizes organizational strategy, operational execution, and resource allocation based on data and sound reasoning.
• Assesses, develops, recruits, and organizes providers for all networks.
• Serves as the liaison between cross-functional teams and provides subject matter expertise.
• Participates in Governance meetings to understand market needs.
• Monitors industry trends in clinical approaches and operations research, identifying implications for the organization and/or clients.
• Establishes and nurtures strong relationships within Lumeris operational areas and regional market partners to ensure needs are understood and being met.
• Supports business areas when roadblocks are encountered and aids generation of creative terms to resolve impasses and establishing walk-away points. Takes into account prevailing local market information when recommending solutions.
• Provides mentorship and indirect oversight for cross-functional teams which may include review of quantitative modeling of deal terms.
• Owns and/or supports multiple concurrent value-based negotiations with providers, including
• process management of negotiation process, development of work plans and meeting materials, and facilitating negotiation sessions and internal Lumeris/client preparation meetings.
• Negotiates hospital, physician, and ancillary provider contracts for existing service areas & expansion areas.
• Compiles, maintains, and analyzes plans' physician fee schedules including participating specialists and non-par physicians for the purpose of identifying cost savings opportunities.
• Compiles, maintains, and analyzes plans' hospital rates for the purpose of identifying cost savings opportunities leading to local initiatives.

Qualifications

• Bachelors degree or equivalent
• 12+ years of experience or the knowledge, skills, and abilities to succeed in the role
• 5+ years of program, project, or team leadership experience in payer/provider value-based negotiations and/or managed care contracting or the knowledge, skills, and abilities to succeed in the role
• Expert Knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs
• Highly skilled at negotiating value based contracting arrangements
• Experience in capitation, division of financial responsibility (DOFR) and Medicare Advantage risk arrangements
• Substantive knowledge of managed care policy and direction
• Strong communication and negotiation skills

Preferred

• Master's degree
• Leadership experience with the proven ability to coach, develop, guide, and support a team

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$98,400.00-$132,225.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position:

No- Not Member Facing Position

Location:

Missouri

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.