VP, Payor Relations

Thrive Skilled Pediatric Care’s purpose is simple, to provide high quality clinical home care to medically fragile children so they can grow and flourish to their full potential. We deliver this through our commitment to our purpose, through our passion for what we do, and pride in what we contribute to which is the health and well-being of children and their family. 

The Vice President, Payor Relations is responsible for overseeing the payor relations operations and strategy within Thrive Skilled Pediatric Care. This role involves strategic leadership, contract management, operational oversight, financial performance, and ensuring compliance with industry regulations. The VP of Payor Relations works closely with the Senior Leadership team to integrate operations and strategies with the overall goals of the organization.

HIRING REQUIREMENTS

• Master’s degree preferred. Bachelor’s degree required with a minimum of 8 -10 years of extensive experience in a leadership role with healthcare providers or payors with oversight of payor contracting and payor relations.
• Experience leading cross functional teams with large payor initiatives. Proven ability to promote a culture of continuous improvement and excellence.
• Strong understanding of value-based care programs with a proven track record of obtaining and managing value-based contracts
• Proven ability to collaborate with internal stakeholders including finance, clinical, operations, business development and health delivery teams.
• Success in leading teams through multi-site and multi-state payor contract negotiations, implementation, and management.
• Possess critical thinking skills necessary to analyze data and synthesize complex information.
• Strong knowledge of and experience in process improvement and facilitation.
• Demonstrated skills and experience in collaboration, negotiation, problem identification and resolution.
• Advanced knowledge of Microsoft Excel, Word, PowerPoint.

ESSENTIAL RESPONSIBILITIES

• Provide vision and direction for payor relations, including value-based care initiatives and payor relationships.
• Lead the negotiation, implementation, and management of contracts with health plans, insurance companies, and payors.
• Develop and implement payer strategies and value-based care reimbursement strategies that optimize clinical outcomes and achieve positive financial performance.
• Ensure contracts are financially viable and aligned with Thrive Skilled Pediatric Care’s goals.
• Manage and optimize payor relationships to enhance contract performance and facilitate resolution of issues.
• Liaison for revenue cycle teams for troubleshooting payment and collection issues with Payers.
• Partner with senior leadership team to implement strategic initiatives that lead to payer optimization and improved financial performance.
• Ensure that payor contracts and practices comply with regulatory requirements and industry standards.
• Develop and monitor metrics to asse and improve the quality of care provided under payor agreements.
• Spearhead business development efforts through utilizing payer relationships to access new channels and patient populations.
• Collaborate with senior leadership to address and resolve compliance issues and audit findings related to payor contracts.
• Assist senior leadership to grow the company's footprint in new and existing markets by leveraging payer relations to identify opportunities to expand market presence.
• Perform other duties as assigned.

KNOWLEDGE AND SKILLS

• Able to effectively collaborate with others to create mutually agreeable solutions that are aligned to our mission and strategic objectives.
• Makes good decisions based on analysis, wisdom, experience and judgment.
• Exercises a degree of creativity and latitude to adapt to changes in the business.
• Effectively communicates with people at all levels in the organization as well as with patients, patient families, and payors.
• Comfortable creating and participating in healthy conflict.
• Flexible and able to manage multiple and competing priorities.
• Ability to handle high-pressure situations with a focus on achieving results.
• Exceptional problem-solving and analytical skills.
• Able to build trusting relationships.
• Demonstrates dynamic interpersonal skills.
• Ability to build a cohesive and collaborative team that meets strategic and operational goals and initiatives.

CORE COMPETENCIES/ATTRIBUTES

• Embraces Healthy Organization culture and lives/promotes Thrive SPC’s Core Values.
• Consistently exceeds goals; pushes self and others to excellence.
• Steps up to and resolves conflicts in an emotionally intelligent manner.
• Sets and models high performance and behavior standards and holds team members accountable through regular performance reviews as well as by delivering ongoing feedback. 
• Promotes programs that support community concerns within our region/locations.
• Demonstrates empathy for the concerns of others within and outside the organization.
• Acts with the greater good of our client and organization in mind.
• Recognizes and communicates the need for initiatives to yield a financial return.
• Sought out by others for advice and solutions.
• Solves difficult problems through rigorous analysis, probing of resources and by looking beyond the obvious.
• Pursues everything with energy, drive and a need to finish; meets commitments.
• Maintains a high level of professionalism and courtesy.
• Able to multi-task in a fast-changing and paced environment.
• Positive attitude and willingness to handle whatever is needed to serve our team members and patients.
• Desire to grow and learn.
• Takes initiative and drives for excellence.
• Promotes teamwork and collaboration. 

TRAVEL REQUIREMENTS

• 50% Travel

ESSENTIAL PHYSICAL DEMANDS

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is occasionally required to sit; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.