Director of Healthcare Economics

Multi-State and Multi-site Dermatology Group Seeks Director of Healthcare Economics and Payor Partnerships

Optima Dermatology is recruiting a Director of Healthcare Economics and Payor Partnerships to continue Optima’s commitment to make payor partnerships a strategic advantage for our practice. This full-time position is based out of our Portsmouth, NH corporate office.

Position Details:

Our philosophical approach toward Payors at Optima is one of collaboration to bring our patients and our Payorpartners’ members value, including our unique approach toward increasing access to the highest quality care. We have built strong payor relationships by demonstrating the value we add through increased access to high quality dermatologic care in underserved areas. The shared goal between Payors and Optima of early detection and treatment affords better patient outcomes with less invasive procedures and can significantly reduce healthcare costs for both patients and Payors. 

In this role, you will function as the primary liaison between Optima and our Payor partners. This includes leading all negotiations and contract language review, relationship development, maintenance, management, and fostering innovation in population health with health plan partners across all business lines.

The role also requires significant technical expertise, as you will execute all analytics related to market position, pricing models and fee schedule analysis, and continuously enhance Optima’s database, processes, and analytics for payor contracting.

Responsibilities:

Deals/Negotiations

• Relationship Management: Develop, maintain, and manage strong and collaborative relationships with all Payors, supported by the following:
  • Presentations: Develop and continuously improve Optima’s value proposition presentation materials for all Payor related discussion, both internal and external.
  • In-Person Meetings: Maximize in-person meetings, including site visits, open houses, and any other opportunity to connect.
  • Relationship Development: Outreach periodically with practice updates, especially during non-negotiation periods.
  • Initiate Negotiations: Provide notice of termination or notice of intention to open the contract at least six (6) months before deadline.
• Modeling: Use analytical and technical skills to model Payor position in each market.
• Models must be built for each negotiation and account for revenue, utilization, provider type, and lines of business, and product differentials.
• Overall position for each region should be modeled to understand market trends and support rate increase requests.
• Models should be built to provide simulation options of various scenarios.
• Negotiation Strategy: Map out a clear strategy for each deal in advance of discussions with Payors.
• Lead negotiations with Payors: Keep detailed notes of all communications throughout the process within Optima’s CRM.
• Contracts: Review and negotiate contracts through to signature (including managing Optima leadership review and approval), particularly for any terminations or contract extensions.

Documentation

• Maintain detailed notes of all communications with Payors, particularly contact details, communications (calls and emails), updated strategies on how to achieve goals, and planned next steps in our CRM (Salesforce).

Project Management

• Utilize Asana for project management and prioritization of deals, goals, request intake and prioritization, and other action items and assignments to individuals on the Optima team.
• Manage any external consultant relationships in conjunction with Optima leadership as required.

Chargemaster

• Review chargemasters following the completion of deal negotiations, and not less than every six (6) months to ensure charges are never less that highest contracted rate.

Deal Grid

• Maintain detailed tracking of all Payor contract renewals and notices, and deal terms and update any time a deal is completed. Review on a weekly basis with Optima leadership.

Target Deal Outcomes

• Planned deals for the next twenty-four (24) months with targets.

Key Performance Indicators (KPI’s)

• Track and report on department KPIs tracked monthly.

Contracts & Amendments

• Maintain contracts and fee schedules for all Payors.

Key Competencies:

• Self-motivated in high pace / high growth independent practice environment.
• High attention to detail & highly organized.
• Strong ability to manage to multiple deadlines and closing the loop with key stakeholders.
• Expertise in producing detailed analyses, modeling, collecting data for negotiations; with the ability to design and produce data models.
• Strong project management skills.
• Technologically savvy with the aptitude to learn new systems and processes that drive efficiencies. Examples include: Salesforce (CRM), Asana (project management), Modernizing Medicine (practice management), Microsoft Office, including Excel (modeling), navigating SharePoints and other file management applications.
• Honest, transparent, and trustworthy with a strong character.
• High energy, passionate, proactive, and result-driven.
• Able to build constructive relationships (both internal and external) to achieve organizational goals.
• Resourceful/self initiative/creative; able to find ways to overcome barriers to success.
• Quick learner with independent decision-making abilities.
• Proven experience in payor contracting / healthcare economics
• Strong work ethic; will get the job done, self-starter, energized by fast paced environment.

About Optima Dermatology

At Optima Dermatology, our mission to revolutionize skin care is made possible by our world class team that is highly engaged, mission-driven, and inspired to set the new standard in dermatology. We are growing rapidly and looking for key team members who believe in our mission and want to make a difference in the lives of our patients. We foster a collaborative environment that is fun and hardworking and promise you will work alongside amazing colleagues you are proud to call your teammates.