Your Future is our Future

At Lumeriswe believe that our greatest achievements are made possible by the talent and commitment of our team members. Thats why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Position Summary:

Job Description:

Primary Responsibilities

• Informs and optimizes organizational strategy operational execution and resource allocation based on data and sound reasoning.
• Owns network pricing and value-based care modeling using the MedInsight tool.
• Owns reporting and insights around network adequacy using cost and quality data.
• Develops Network Business Intelligence analytic tools so the team can self-serve frequently requested analyses using dashboards.
• Closely collaborates with contracting leadership to prioritize the teams analytic priorities.
• Participates in Governance meetings to understand market needs.
• Monitors industry trends in clinical approaches and operations research identifying implications for the organization and/or clients.
• Establishes and nurtures strong relationships within Lumeris operational areas and regional market partners to ensure needs are understood and met.
• Supports business areas when roadblocks are encountered and aids in the generation of creative terms to resolve impasses and establish walk-away points. Takes into account prevailing local market information when recommending solutions.
• Provides mentorship and indirect oversight for cross-functional teams which may include review of quantitative modeling of deal terms.
• Owns and/or supportsmultiple concurrent value-based negotiations with payers including process management of the negotiation process development of work plans and meeting materials and facilitating negotiation sessions and internal Lumeris/client preparation meetings.
• Supports Network Contractors on hospital physician and ancillary provider contract strategy development for existing service areas and expansion areas.
• Compiles maintains and studies plans physician fee schedules including participating specialists and non-par physicians for the purpose of identifying cost savings opportunities.
• Compiles maintains and studies plans hospital rates for the purpose of identifying cost savings opportunities leading to local initiatives.
• Owns CMS Network Access and Adequacy reporting including analysis of results and strategy recommendations on gap closure as well as marketability analysis. The position will also be responsible for HSD filings in support of Network including acting as the designated subject matter expert and primary relationship owner with J2.

Qualifications

• Bachelors degree or equivalentin Business Finance Data Analytics Mathematics IT or a related field.
• 12 years of experience or the knowledge skills and abilities to succeed in the role.
• Proficiency in SQL Tableau or Power BI with at least 8 years of experience required.
• Excellent project management skills with the proven ability to impact results.
• Highly skilled at payer/provider value-based negotiations and/or managed care contracting.
• Expert knowledge of provider contracting/negotiations network development and configuration standards for managed care delivery and cost containment programs.
• Woking knowledge of negotiating multiple gain share arrangements.
• Experience in capitation division of financial responsibility (DOFR) and Medicare Advantage risk arrangements.
• A strong ability to prioritize and organize work with varying timelines for projects and daily work.
• Strong communication and negotiation skills.

Preferred

• Masters degree.
• Leadership experience with the proven ability to coach develop guide and support a team.

Working Conditions

While performing the duties of this job the employee works in normal office working conditions.

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills experience qualifications location and comparison to other employees already in this addition to the base salary certain roles may qualify for a performance-based incentive and/or equity with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

Benefits of working at Lumeris

• Medical Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO Sick Time Paid Leave Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

Location:

Time Type:

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed at a minimum the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities duties and skills required. The physical activities demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.