Out-of-state government programs:

• Synthesizing information related to out-of-state public payors across business lines, identifying and tracking trends and developments in publicly-financed pediatric care that affect delivery of care in national markets in collaboration with Finance/Contracting, Patient Services, and Information Technology. Collaborating with Clinical leadership, Finance/Decision Support, Marketing, and external consultants to obtain, analyze and interpret key information.
• Promoting all services of the Hospital and its physicians through outreach, education and network development efforts aimed at government payors and Medicaid managed care entities. Overseeing lobbyists and consultants supporting out-of-state Medicaid negotiations, contracting and dispute resolution processes.

Payor relations:

• Developing and maintaining trusting relationships with government and commercial payor leaders and out-of-state providers to increase understanding of the referring external partners needs and expectations. Serving as a liaison/facilitator of communication between hospital executive and clinical leaders with external counterparts.
• Leading Payor Relations team to support the enterprise in partnering with payors to overcome administrative and operational barriers to improve patient access and revenues.
• Supporting the implementation of patient engagement and provider continuing education strategies relating to providing access and assuring fair reimbursement for in state and out-of-state patients and families, especially those with medically complex conditions. Assisting in the development of educational materials.
• Supporting coordinated policy responses, with VP of Government Relations, related to Massachusetts insurance and provider rate-regulation and oversight. Substantial interface and tracking of Health Policy Commission, Attorney General, and Department of Public Health regulatory processes as they pertain to government and commercial payors.
• Supporting analysis of Massachusetts Medicaid provider contracts, rate and policy changes to understand specific impacts to the pediatric population and to the enterprise.
• Supporting growth and assisting in execution of strategies that improve enterprise ability to attract, retain and deliver care to complex patients. Developing and presenting communications about strategic options to Finance/Contracting, Network Development and Strategic Partnership leadership and enterprise leadership to guide decision-making.

To qualify, you must have:

• Bachelor’s degree required, Master’s degree preferred.
• All necessary state and federal lobbying registration and compliance required.
• 10 years of progressively responsible experience in the development, evaluation and execution of strategic initiatives for a complex health care organization or healthcare-related field.
• 7 years of business/health care analytics experience and experience with contract development and evaluation.
• Experience in state budget processes and procurements desired.
• Knowledge related to the interpretation and drafting of regulatory and policy-related materials, including those involving payor and provider payment and performance methodologies and standards.
• The ability to develop and evaluate enterprise-wide strategic project initiatives for a complex health care organization.
• High-level analytical capabilities and excellent quantitative skills and attention to salient details.

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, childcare and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.