Director of Payer Innovation Analytics

Health Plan Strategy & Contracting

Full Time

83116BR

Job Summary

In support of UCSF Health's strategic goals and objectives, this position is responsible for preparing department leadership for payer negotiations through the development of standard approaches to pricing strategy recommendations derived through innovative market research, market intelligence, collaboration with UCSF Strategy, and analytics using internal and external market data and applying sophisticated financial data system analytics and expertise, forecasting, healthcare risk-adjustment models/tools to inform market changes, pricing, and trends for all hospital, medical group, transplant, and joint venture commercial, Medicare Advantage, Medi-Cal managed care, and all other payer contracts, including those involving Center of Excellence (COE) contracts, risk-bearing Accountable Care collaborations, and value-based agreements. For example, as a support analyst to HPS' Director of Contract Modeling & Analytics and as support to HPS' Contracting team determining priority service lines for rate differentiation and incorporating these recommendations in the strategic planning process, and identifying value-based contracting performance improvement opportunities are key functions of this position. Additionally, responsible for creating and populating contract negotiation preparation tools with historical and market data, rate equivalencies, and other critical elements to evaluate and prepare for a negotiation; analytical support of all UCSF Network division contracting; and providing full support to those Health Plan Strategy team members responsible for contract modeling and reporting functionalities. This position is also accountable to and responsible for supporting HPS Contract Modeling team and providing key performance indicators competitive market intel and payer ranking that feeds management-level dashboard reports under the leadership of the HPS Director of Contract Modeling & Payer Revenue Integrity. Responsible for assessing payer and provider available Transparency data and providing the Director of Contract Modeling and HPS Contracting team with market-available competitive payer data to inform recommended payer strategies. Populates and recommends Target and Minimum renewal parameters and reimbursement terms payment provisions to support improved payer contract performance.

The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement. The annual salary range for this position is $129,600 - $303,800, with a target entry point starting at $202,800+ based on experience. To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html

Department Description

UCSF Health's Health Plan Strategy & Contracting department (HPS) is responsible for the negotiation and relationship management of all-payer contracts for UCSF's hospitals, medical groups, transplant programs, and joint ventures with commercial, Medicare Advantage, managed Medi-Cal, and all other payers, along with contract modeling and negotiation analytical support. Commercial, Medicare Advantage, and managed Medi-Cal contract revenues are over $4.6 billion annually, accounting for two-thirds of all UCSF Health's clinical revenue.

Contracts include HMO, PPO, ACO and extensive COE agreements, as well as specialized government contracts. In addition to long-term payer contracts, HPS annually negotiates more than 1,000 individual patient service agreements. HPS negotiates these individual agreements when payers do not have a formal contract with UCSF Health, mostly for government programs, such as Medi-Cal Managed Care and Medicare Advantage payers, helping to ensure that patients have regional access to necessary specialty care.

Required Qualifications

• Bachelor's degree in a related area or four years of relevant experience.
• A min. of five years of the following:
  • Expert knowledge of managed care principles, contract provisions, rate structures, and capabilities to support payer contract negotiations.
  • Highly developed technical expertise to innovatively measure, evaluate, and recommend modifications to optimize the functional, operational, and financial performance of managed care contracts.
  • Highly developed customer service and interpersonal skills for representing the health system positively and effectively in working relationships with MCOs.
  • Exceptional organizational, analytical, and critical-thinking skills to understand highly complex and sensitive situations, quickly identify and resolve difficult problems, and to manage and prioritize multiple levels of information and responsibilities.
  • Expert user of managed care application programs, including longitudinal data methods. Ability to review contract databases and synthesize data to generate comprehensive narrative and statistical reports for management use.
• Highly-developed communication skills to effectively convey complex, detailed information clearly and concisely to clients, management, and all levels of personnel.

Preferred Qualifications

• Master's degree or higher level education
• Knowledge of trends and developments in the managed care industry, both public and private, including new business development.
• Demonstrated experience analyzing and recommending optimal managed care revenue rate structures for new business opportunities.
• Knowledge of Managed Care, health system, HR, and UC policies and processes.
• Expert knowledge of relevant industry federal, state, and local laws and regulations to improve internal policies and processes.
• Expert ability to provide strategic advice to senior management regarding a wide range of contracting operations and strategies.
• Participates in the establishment of new contracts and the development of expanded offerings in the managed care service line.
• Strong experience leading a team of highly skilled analysts; exhibiting leadership, employee engagement, and employee development capabilities.
• Knowledge of UCSF Operations.

License/Certification

Certification: EPIC (APeX) Payment Modeling

About UCSF

At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve - a promise we share with the professionals who make up our team.

Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report - UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Organization

Health

Job Code and Payroll Title

005759 MGD CARE SPEC 5

Job Category

Accounting / Finance, Business Development, Financial, Strategy

Bargaining Unit

99 - Policy-Covered (No Bargaining Unit)

Employee Class

Career

Percentage

100%

Location

Brisbane, CA

Campus

Brisbane

Work Style

Hybrid

Shift

Days

Shift Length

8 Hours

Additional Shift Details

M-F