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Beth Israel Lahey Health · 7 hours ago

Director, Payor Operations

Wakefield, MA

Full-time

Onsite

Lead/Staff, Director/Executive

$160K/yr - $185K/yr

3+ years exp

Beth Israel Lahey Health is a growing healthcare organization making a difference in people’s lives. The Director, Payor Operations will oversee operations and payer partnerships, ensuring compliance and successful program outcomes while developing strategic business plans in support of the organization’s mission.

Elder CareHealth CareHospitalPrimary and Urgent CareProfessional ServicesTraining

H1B Sponsor Likely

Responsibilities

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

Qualification

Managed care operationsPayer partnershipsProject managementFinancial managementQuality improvementCustomer serviceDecision makingProblem solvingTeam workWritten communicationsOral communications

Required

Bachelor's Degree required

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

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

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

Ability to make decisions that are guided by precedents, policies and objectives

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

Ability to set goals and priorities for functional area

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

Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others

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

Ability to lead collaborative teams for larger projects or groups both internal and external to BILHPN and across functional areas

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

Preferred

Master's Degree or similar advanced degree preferred

Company

Beth Israel Lahey Health

Glassdoor3.5

Beth Israel Lahey Health Center offers patient care, urgent care, assisted living, and research and education services.

Founded in 2019

Cambridge, Massachusetts, USA

10001+ employees

https://www.bilh.org

H1B Sponsorship

Beth Israel Lahey Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2024 (2)

2022 (1)