Director Payor Relations Value Based Care-SWHR

Director Payor Relations Value Based Care-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 value based payor agreements. Develops and manages payor and employer contracts that align with the delivery of value based care.  Maintains an advanced understanding of financial analytics, quality and utilization components of value based care.  Develops communication materials and maintains relationships with internal stakeholders and payors. Responsible in supporting to operational framework of managed care operations teams within SWHR.

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

Position Duties

Maintains JOC's and operations meeting with payers appropriately collaborating with internal stakeholders on action items from prior meetings. Monitors value based performance of contracts, including financial, quality, and utilization and acts as liaison between internal stakeholders and payers.

Requests, reviews and understands value based financial analytics in support of contract negotiation, contract performance and budgeting activities. Maintains a thorough understanding of contractual components to support the operational infrastructure and network of SWHR.

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

Serves as the Direct to Employer value based subject matter expert to help contract and implement employer agreements. Understands the full SWHR Network and ability to contract for all providers and facilities in support of the network distribution strategy.

Develops and implements policies and procedures for operation of unit.

Keeps up to date with industry trends, payor trends and overall market trends.

Performs other duties as assigned.