Director - Managed Care Transplant (Specialty Services)

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This is a Stanford Health Care job.

A Brief Overview
Responsible for advancing relationships with payers and pharmacy benefit managers (PBMs) to effectively negotiate transplant, high-cost drugs, pharmacy, and other specialty services contracts. Ensures that contract negotiations meet the financial, operational, and strategic goals of Stanford Health Care (SHC) and Stanford Medicine Children's Health (SMCH). Develop, execute, and sustain SHC and SMCH payer strategy strategies for applicable agreements.

Locations
Stanford Health Care

What you will do

• Provides leadership and subject matter expertise to Managed Care department and various other SHC and SMCH departments on matters of managed care strategy, reimbursement, cost, payer mix, and other contract specific issues.

• Represents the Managed Care department on cross-functional committees across the SHC and SMCH Enterprise.

• Monitors industry trends to identify opportunities and risks for the SHC and SMCH Enterprise.

• Collaborates with senior management and service lines in the development and facilitation of business development strategies relative to managed care contracting.

• Performs special projects on behalf of Department VP as assigned.

• Researches options for participation in new managed care and Pharmacy Benefit Manager contracts.

• Identifies, researches, and assists with implementing process improvement initiatives on behalf of the Managed Care department.

• Directs contract proposal modeling and miscellaneous analytical activity as assigned.

• 'sNegotiates contract terms and payment rates that are consistent with SHC and SMCH’s financial and legal guidelines, and overall contracting strategies.

• Analyzes contract performance using data maintained by the department and responds quickly and effectively to significant trends.

• Leads the coordination and timely implementation of contracts to include contract review, modeling, execution, storage, and operational readiness.

• Collaborates with senior management, physicians, service line administrators and operational departments to develop an understanding of new high-cost therapies, transplant procedures, technologies, drugs, and other specialty services to ensure that their costs are appropriately reflected and reimbursed in managed care agreements.

• Develops and maintains productive working relationships with internal and external customers to support managed care strategy, contracting and operational effectiveness.

• Responds to physician and administrative concerns relative to contract pricing, cost, managed care, etc. as needed.

• Leads a team of Managed Care professionals and is responsible for creating and maintaining a work climate where employees have a high level of engagement.

Education Qualifications

• Bachelor's Degree in a work-related discipline/field from an accredited college or university. Required

• Master’s Degree in a work-related discipline/field from an accredited college or university.
  Preferred

Experience Qualifications

• Ten (10) years of progressively responsible and directly related work experience Required

• One (1) year of leadership responsibility. Required

Required Knowledge, Skills and Abilities

• Ability to communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating conflict resolution, consulting and advising as well as prepare clear, comprehensive written and oral reports and materials.

• Ability to establish the strategic direction and business plans for a functional group.

• Ability to manage, coach and develop employees.

• Ability to negotiate and manage contracts and service agreements.

• Ability to solve problems and identify solutions.

• Knowledge of health care, marketing, managed care strategy, financial/contract analysis and the medical reimbursement environment.

• Ability to be detail-oriented and to function with interruptions.

• Ability to maintain a friendly, helpful and professional attitude under stress.

• Ability to work on a team and meet expectations where others depend on you.

• Ability to maintain confidentiality of sensitive material.

• Ability to multi-task in a busy environment with a high degree of accuracy and efficiency.

• Ability to speak, read, write, and understand English effectively at a level appropriate for the job.

• Knowledge of computer systems and software used in functional area.

• Knowledge of HIPAA and how to be compliant in the workplace.

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.