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Director, Contracting & Operations - Managed Care

Job ID 146862 Date posted 06/20/2018

Position Summary:
Reporting to the Vice President, Contracting for Lahey Health System, the Director of Contracts is responsible for managing legal review, policy compliance, contract retention and administrative tracking of all contracts to which Lahey Health, including its subsidiaries and affiliates, is a party. Will manage negotiation and execution of managed care contracts between Lahey Clinic Performance Network, other Lahey entities, affiliated providers and various managed care payers. Advances LHS payer strategy and aligns negotiation with strategy.

Essential Duties & Responsibilities including but not limited to:
Leads the managed care contracts process, including initiate, plan, finalize, implement, report (written and verbal) and direct all related negotiations.

Oversee the execution of managed care contracts with pertinent staff.

Coordinate finance and operational reviews, including quarterly meetings with LHS contract entities including behavioral health, international, home care and non-LCPN contract reviews.

Partner with the Vice President, Contracting to negotiate and manage major LCPN system risk contracts.

Responsible for creating presentation materials for presentations to senior leadership and Board members.

Update and redesign the contracts database system for management, retention and retrieval.

Represent the function to stakeholders on contracts implementation and review at stakeholder meetings.

Serves as key liaison between Contacting Department and Lahey Clinical Performance Network (LCPN).

Oversee transplant contracting.

Design, implement and maintain contracting processes for single case rate agreements.

Manage contract activity for Behavioral Health, Home Health, International Health and the Transplant Team.

Responsible for managing staff, with focus on staff development. Ensures staff is balancing competing major priorities.

Responsible for managing the department budget.

Drives other projects, as assigned.

Organizational Requirements:
Maintain strict adherence to the Lahey Health Confidentiality policy.
Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
Comply with all Lahey Health Policies.
Comply with behavioral expectations of the department and Lahey Health.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.


Minimum Qualifications:

Education: BS/BA required. Masters or MBA preferred.

Licensure, Certification & Registration: None required

Minimum 10 years experience in healthcare risk contract negotiation, management, review and drafting.
Experience with behavioral health and/or international health contracting preferred
5+ years? experience managing and leading staff.
Strong contract negotiation skills in managed care.
Strong financial acumen.
Ability to establish solid relationships, both internally and externally.
Requires ability to be flexible and adaptable to regularly re-evaluate and prioritize work projects.
Must have strong project management skills.
Requires strong communications and presentation skills.



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

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