About Us
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.
Director Payor Contracting McLaren Physician Partners
Supports the overall direction and coordination of Third Party Payor contracting activities within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC) and its subsidiaries. Conducts contract modeling and analysis with an understanding of population health and value-based contracting, while regularly advises VP of contract performance and risk. Professionally and effectively communicates the advantages of contracting with McLaren, provides ongoing expertise throughout the contracting process and administration of payor agreements. Key team resource for MHCC and its subsidiaries, providing ongoing expertise throughout the contracting and administration of the payor agreements. Co-Manages Contracting team and monitors performance.
Essential Functions and Responsibilities As Assigned:
Responsible for executing contracting activities with Third Party Payors as assigned. Collaborates on strategic planning of contracting activities.
Resource for all contracting activities of MPP, MHCC and its subsidiaries, including providing ad hoc assistance and support as requested. This includes, but is not limited to review, redline, and evaluation of language of the Managed Care contracts. In addition, participates and leads negotiations, and identifies any issues and coordinates contract workflow/approval through to contract execution.
Develops and implements policies and procedures to monitor contractual obligations and ensure compliance with such (i.e. annual performance benchmarks, payment rate changes, etc.).
Analyzes changes in legislation, payer policies, rules and regulations impacting both facility and physician payments, including but not limited to monitoring industry developments. Communicates and educates those impacted, as necessary.
Defines priorities and communicates to staff departmental goals and works with them to achieve them; seeks commitment from staff, encourages innovation and motivates through team building/planning.
Acts as liaison between contracted Health Plans and MPP, MHCC, MHPN and subsidiaries, including but not limited to, research operational issues and review of payor policies needed to resolve issues.
Required:
Bachelor’s degree in business, health care or related field.
Ten (10) years’ experience in complex provider contracting and servicing in a managed care organization, Health System, Health Plan, PHO, PO or similar organization, including three (3) years in a management role with direct reports, leading or in all phases of effective supervision (i.e. Recruitment, performance management, training).
Preferred:
Master’s degree in health care management, Finance or related field.
Experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
