Director, Payer Contracting
At UpStream, we are dedicated to promoting good health and empowering individuals to lead independent lives. As a trusted partner to primary care physicians, we offer effective and sustainable care options, focusing on seniors and those with chronic conditions. Our comprehensive solution allows physicians to prioritize patient care while our value-based care model ensures effective condition management.
We prioritize affordability and accessibility, collaborating with healthcare practices and clinics to reduce costs and enhance system efficiency. Through personalized care plans and innovative solutions, we strive to improve health outcomes and enable patients to live fulfilling, independent lives.
How you’ll help
The Director, Payer Contracting is responsible for driving and executing UpStream’s value-based care contracts within the current North Carolina, South Carolina, and Virigina markets, as well as future markets. The Director, Payer Contracting will drive processes and technology improvement initiatives that directly impact revenue and quality metrics. This role will lead the evaluation of prospective payer relationships, analyze risk profiles and market trends while negotiating contracts that align with the strategic growth and positioning of UpStream. The Director, Payer Contracting will utilize extensive marketplace expertise to adjust strategies to negotiate payer contracts while building and maintaining relationships with new and existing payers. This role is responsible for helping shape UpStream’s strategy for value-based contracting by providing strategic planning, tools and continuous improvement processes to support and improve quality and financial performance. The Director, Payer Contracting will represent the scope of payer/provider relationship across various areas, including contract implementation, financial performance, incentive programs, quality and clinical management, population health, HEDIS and STARs performance and other key areas as they relate to provider performance, member experience, market growth and operational excellence.
This position reports to the Chief Financial Officer.
What you’ll do
- Play a critical role in the development of strategies and methodologies as it relates to payer contracting and contract terms
- Negotiate value-based care contracts with prospective payer partners, which includes reading contracts, setting contract terms, tracking deliverables, interfacing with internal stakeholders, and executing contracts
- Work cross-collaboratively with finance, legal and operations to ensure contract terms align with and optimize revenue goals while satisfying legal requirements
- Identify and recommend opportunities for all forms of value-based care contract performance improvement with current customer contracts
- Influence and educate internal and external stakeholders on contracting strategies, marketplace dynamics, healthcare trends, portfolio considerations, communities of practice and payer payment innovations
- Educate internal and external business partners on market movement that influence and impact work, including current and proposed government policy, reimbursement landscape, payer trends, distribution dynamics and legal considerations
- Qualify and source market growth and expansion for multi-year risk arrangements
- Drive and maintain strategic relationships with existing health plan partners and proactively engage with partners in advance of renewals and scheduled negotiations to improve contract terms
- Track and report on ongoing payer discussions, as well as key contract metrics such as renewal dates
- Develop a deep knowledge and understanding of UpStream’s existing contract terms and hold responsibility for new and historical contracts
- Own project performance, risk management, administration, financial management and issue resolution of self-identified or assigned projects with significant scope
Experience and skills you’ll need
- Bachelor’s degree required; Master’s degree in Finance, Business Administration, or Health Administration strongly preferred
- 5+ years’ experience in payer relations, contracts, negotiations and network development
- Proven track record of creating, maintaining and enhancing relationships with existing and prospective customers, as well as communicating effectively with senior leadership
- Extensive knowledge of value-based care plans, Medicare and Medicare Advantage required
- Deep understanding of healthcare reimbursement systems
- Results oriented with the ability to assess financial and operational outcomes of contracts
- Demonstrated organizational skills and the ability to effectively manage competing priorities
- Excellent interpersonal communication and critical problem-solving skills; willingness to challenge yourself and others and take calculated risks to grow the business
- Previous experience working in a fast paced, high growth organization preferred
- Passionate about driving the shift from fee-for-service to value-based care
Location/working arrangements – Remote, Eastern or Central Time Zone preferred. Occasional travel required- approximately 25%
At UpStream we offer a range of benefits to ensure our employees are taken care of. Our health insurance plans through United Health Care include FSA and HSA options, and we also offer dental, vision, life, and accident coverage through Guardian. We immediately match contributions to our 401k plan, which includes both Roth and Traditional options. In addition, we provide financial perks and rewards through BenefitHub, and free access to EAP services through WorkLifeMatters. Our employees also enjoy generous PTO and paid holidays.
We value diversity and promote equal opportunities for all. As an equal opportunity employer, we do not discriminate against applicants based on their race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. All qualified candidates are encouraged to apply.