Director Payor Relations Contract-SWHR

Director Payor Relations Contract-Southwestern Health Resources-Clinically Integrated Network (SWHR-CIN) 

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region’s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N’ Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region. 
 
The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care.  In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation’s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.   
 
At the heart of SWHR are people who help people. We care about those we serve and each other.  To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.  

Position Summary

Provides administrative guidance and operational management of SWHR payor agreements which may include, but not limited to, facility, ancillary and physician agreements or specialty agreements such as transplant, ACO and bundled payment. Develops and implements payor contracting strategies.  Maintains an advanced understanding of financial analytics.  Develops communication materials and maintains relationships with internal stakeholders and payors.

·  Work location: Southwestern Health Resources Headquarters, Farmers Branch, TX.

Position Duties

Conducts and successfully completes, in a timely manner, contract negotiations with payors that meet or exceed the financial and operational objectives of SWHR and SWHR affiliated providers. Proactively enlist legal, operational, and financial input and support to achieve maximum benefit for SWHR and SWHR affiliated providers.

Identifies and develops new business opportunities through pursuing payor contracts. Coordinates and prepares marketing collateral materials, research new products and payor offerings, identifies prospects for SWHR programs and services. Develops and maintains positive business relationships with third party payers.

Requests, reviews and understands financial analytics in support of contract negotiation, contract performance and planning activities. Maintains a thorough understanding of contract language and its implications on SWHR contract performance and obligations.

Monitors performance of contracts, regarding their financial performance, volume trends, product implementation, and acts as liaison between internal stakeholders and payers.

Coordinates SWHR's interaction with other affiliated organizations contracting staff. Keeps up to date with industry trends, payor trends and overall market trends.

Develops and implements policies and procedures for operation of unit.

Serve on, attend, and participate in SWHR committees, meetings, and functions as requested.

Performs other duties as assigned.