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When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

The Director, Payor Operations will assist in overseeing and managing operations and payer partnerships for all BILHPN contracted payors. The Director will help develop and implement strategic business plans in support of BILHPN’s mission.

This position ensures compliance with all Payors and State obligations, as well as successful outcomes of program goals and metrics.

Job Description:

• Manages contract deliverables and requirements that may include: being a Risk Bearing Provider Organization (RBPO) and Certified ACO and payer submissions, processes, and tracking.

• Directs BILHPN wide aspects of payor program design and development, establishing goals and metrics that support payer goals, requirements and obligations. Examples can include development of payer dashboard, leading or supporting workgroups, or providing proposals/advisement for payer impacts.

• Serves as a liaison and expert with our payers and relevant stakeholders, which may include state and federal agencies on matters pertaining to the ACO on behalf of BILHPN or direct payer relationships to strengthen our payers relationships.

• Identifies system integration needs and collaborates with IT or other divisional departments across BILH to develop project plans to meet payor goals. Develops and implements evaluation tools and processes to enable executive review of program performance.

• Works with payor and consumer stakeholders on delivery system reform efforts that impact BILHPN.

• Mitigates risks and ensure the business is successful in meeting its goals and objectives.

• Plans, develops, and reviews materials for education of network members and providers. Tasks can include payment policies.

• Assists department leadership with planning department budget, as applicable • Participates in the process of identification of performance improvement projects, including creating the associated analytics and financial justification and communicates effectively with cross-functional teams.

• Carries out cross functional tasks to achieve critical milestones.

• Ensures expenses stay within project budget.

• Uses critical thinking skills to analyze information, develop solutions and propose alternative action plans. Examples can include evaluation of contract opportunity.

• Participates in establishing and implementing project communication plan including progress reporting mechanism to keep project sponsor, key stakeholders, senior management, external leadership and various committees up to date with the progress of the projects.

• Oversight of day to day operations within the department division.

• Performs all other duties as needed or directed to meet the needs of the department.

Education: Bachelor’s Degree required; Master’s Degree or similar advanced degree preferred.

Licensure, Certification & Registration: None

Experience:

1. 3 - 5 years of experience in managed care operations, with working knowledge of finance, practice management, and quality improvement relevant to outpatient care.

2. Experience in planning, developing, organizing, financing, staffing, problem resolution, delegating, marketing, executing and evaluating performance must be demonstrated.

3. Prior experience managing a highly complex situation and/or a medical group affiliated with hospitals.

4. Experience in planning, developing, organizing, financing, staffing, problem resolution, delegating, marketing, executing and evaluating performance.

Skills, Knowledge & Abilities:

• Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.

• Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.

• Independence of Action: Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Director provides broad guidance and overall direction.

Written Communications:

Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.

• Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.

• Knowledge: Ability to demonstrate broad and comprehensive knowledge of theories, concepts, practices and policies with the ability to use them in complex and/or unprecedented situations across multiple functional areas.

• Team Work: Ability to lead collaborative teams for larger projects or groups both internal and external to BILHPN and across functional areas. Results have implications for the management and operations of multiple areas of the organization.

• Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.

Pay Range:

$159,994.00 USD - $184,995.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled