Texas Health Resources Senior Director Payor Relations and Contracting-SWHR CIN in Dallas, Texas
Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Senior Director Payor Relations and Contracting.
The Senior Director of Payor Relations and Contracting supports the managed care contracting activities of Southwestern Health Resources (SWHR). SWHR contracts on behalf of Texas Health Resources, UT Southwestern, the physicians employed by both entities, and more than 500 community primary care physicians. Contracts include both fee-for-service arrangements through full-risk, fully delegated arrangements. SWHR has more than 700,000 lives in some type of value-based arrangement. Contracted services include: hospitals, outpatient services, ancillary services, physician services, specialty services such as transplants, etc. This position will have a leadership position for physician contracting and all SWHR value-based agreements.
Location: Farmers Branch
• Full time, Monday through Friday, 8am-5pm
Helps to drive Southwestern Health Resources payor relationship management, with the objective of developing and implementing a strategic and tactical managed care contracting plan that serves stakeholders and the organization that will result in improvements in the health of the communities that SWHR serves.
Leads development and execution of payor tactical operating plans for physician, or value-based agreements that support the achievement of strategic and financial objectives.
Supports leadership in educating both THR and UTSW leadership, Central Business Offices and other internal groups to inspire their understanding of managed care management as one of the organization's imperatives and to ensure effective coordination of strategies and tactics.
Educates and partners with SWHR operational units (e.g., quality, care management, network, etc.) to support the overall management of managed care contracts, particularly those with a value-based component.
Recommends and shapes organizational perspective on various reimbursement and managed care contracting issues and represents SWHR position on these to relevant internal and external constituents.
Represents SWHR in collaborating and partnering with various external managed care stakeholder groups in the communities SWHR serves.
Guides development and measurement of Key Performance Indicators to monitor managed care activities.
The ideal candidate will possess the following qualifications
Bachelor's Degree BBA, BA, or BS required
Master's Degree Healthcare related field preferred
8 years progressively complex management experience in managed care, insurance management and/or a health care environment (e.g., contracts and implementation) required
* Value based contracting experience is highly preferred *
Thorough understanding of provider reimbursement, financial analysis, provider contract analysis, HMO/PPO operations, hospital/physician administration, insurance/provider risk, excellent communication, negotiation, decision making skills
Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region’s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N’ Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.
The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation’s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at www.southwesternhealth.org.
Let’s move healthcare forward – together.
Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.