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:

Reporting directly to Jim Beiermann, Senior Executive Officer of Southwestern Health Resources, and in partnership with its parent organizations, the Chief Payor Relations Officer will be responsible for developing and executing a payer strategy that is aligned with the companies’ organizational goals and enables the organizations to succeed in a dynamic reimbursement environment. This executive will have oversight of the entirety of the managed care functions across both UT Southwestern and Texas Health Resources, representing $4.7 billion in at-risk contracted revenue through SWHR.

The Chief Payor Relations Officer will be a dynamic leader who can espouse the vision and value proposition for partnership with SWHR in managing total cost of care and quality for employers and health plan partners.This leader will manage the relationships with and earn the respect of traditional managed care organizations as well as consultants/brokers, employers and governmental agencies. The Chief Payor Relations Officer will be expected to coordinate efforts with the leaders and governance of hospitals, physician groups and population health services, which are part of the SWHR organization, and ensure that the best interests of both partners – representing both community-based hospitals and academic medicine – are served in contracting functions on behalf of the whole.

The Chief Payor Relations Officer will interface with key leaders across the organization to effectively coordinate contracting initiatives for healthcare products and services. The successful candidate will be responsible for creating and leading a strategy that optimizes revenue while assessing both fee-for-service and value-based payment methods, ranging from upside-only risk to full capitation, evaluating new market offerings such as limited and tiered network products and considering new market opportunities like telehealth and national and international purchasers, as well as direct to employer relationships. This leader will incorporate feedback on payment design with the Physician Network, Population Health Services Company, Care N’ Care insurance company and Hospital Network, as well as the two parent organizations. The successful candidate will serve as a steward of fiscal resources, with the primary mission to achieve the revenue and market share goals of SWHR and its affiliate organizations.

The Chief Payor Relations Officer has the following duties and responsibilities:

Partner with senior leadership to devise payer strategies that align with delivery system requirements and organizational goals and ensure market access, improved care quality and financial strength for SWHR and its partners.
Advance the organizations’ value-based payment strategy through the optimization of existing programs and development of new risk-based reimbursement models and innovative insurance products featuring SWHR’s providers.
Develop and recommend negotiation plans, which will establish negotiating parameters that are aligned with the goals, strategies and objectives of SWHR and its parent organizations and optimize value in the care it delivers.
Partner with internal constituencies to develop strategies that increase competitiveness in the local market while leveraging volumes and strategic relationships.
Collaborate with clinical leaders to develop quality-based metrics and contractual incentives.
Serve as primary representative to the payer and healthcare purchaser market on behalf of SWHR and its affiliated hospitals, ancillary providers, independent practice associations and physician groups.
Build and maintain positive ongoing relationships with all healthcare purchasers, with the objective of maximizing market share for SWHR-affiliated members.
Develop managed care contracting and business implementation strategies with commercial insurance companies, consultants/brokers, employers and government agencies to include Medicare and Medicaid.
Work cooperatively between the healthcare purchaser community and SWHR-affiliated organizations to provide market intelligence and customer feedback, as well as facilitate testing of new ideas, strategies and tactics with the healthcare purchaser community.
Assess new and prospective regulations to determine impacts on contracts and reimbursement, and take appropriate action. Lead development and deployment of an enterprise alternative reimbursement platform to ensure financial payment integrity.
Provide system-wide payer relations management in order to develop strategic and tactical operating plans that support the achievement of the financial and strategic objectives of SWHR.
Support the development of key indicators to monitor payer and healthcare purchaser relations activities. Manage all key indicators to ensure target compliance.
Oversee preparation of financial and statistical analysis and reporting for all payer and healthcare purchaser contracting.
Develop, motivate and mentor a management team with 20 staff to its highest performance. Work to effect positive change. Instill accountability to create a high-performing team.
Create strategic alliances with key internal and external groups to maintain or create a competitive advantage for SWHR and its affiliates.

Experience/Qualifications

Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions. This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner and self-starter. The requirements listed below are representative of the knowledge, skill, and/or ability required to build THR's culture for action.

Bachelor’s degree required (Master’s preferred) in business, health care administration, finance, or related fields.
Ten-plus years of experience negotiating complex managed care contracts involving value-based payments with payer organizations, preferably in an integrated health system with acute care, physician and sub-acute care operations and both academic and community hospitals.
Ideally, experience working with consultants/brokers, employers and direct-to-employer products.
Specific experience and strong track record in developing and executing innovative strategies to address market issues in healthcare including via payer arrangements.
Demonstrated ability to articulate a vision and generate necessary consensus behind implementation through exceptional influencing skills. Is results driven and comfortable implementing and driving change in a highly matrixed environment.
Strong industry knowledge related to value-based care, payment innovation, and provider collaboration.
Experience conducting significant negotiations, bringing a partnership mindset.
Deep understanding of competitive landscape and industry trends in topics such as physician compensation redesign, patient-centered medical homes, full-risk capitation, bundled payments, and commercial and government ACO programs.
Ability to think critically, understand complex concepts and quantitative analyses, synthesize information and make good judgments. Deep understanding of the analysis of data and information, with the capability to support the design, execution and deployment of effective performance dashboards and metrics.
Excellent oral, written, and interpersonal communication and persuasion skills required; ability to break down silos and promote collaboration.
Capable of functioning in ambiguous environments and handling multiple and diverse tasks simultaneously.

Additional Information

Location: Dallas, Texas, United States
Shift: Day Job
Schedule: Full-time

Texas Health Resources

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