Fallon Health

  • Director, Provider Contracting (APM Strategy and Implementation) – Growing Health Plan!

    Location US-MA-Worcester
    Posted Date 3 weeks ago(6/26/2018 4:34 PM)
    Job ID
    # Positions
    Network Development
  • Overview

    The Director of Provider Contracting has overall responsibility for Fallon’s development and execution of Alternative Payment Strategy (APM) and Implementation with providers. The Director oversees provider risk contracting and provider risk contract performance across Commercial, Medicare, and Medicaid products.

    About Fallon Health:

    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.



    • Work with Contracting staff, Clinical leadership, Finance leadership and Provider Relations to plan, develop and implement APM strategies that support corporate strategic objectives to maintain financial viability and meet market demands
    • Develop, implement, and oversee the ongoing maintenance of all risk contract relationships across all product lines
    • Assure all risk arrangements with providers are in compliance with financial requirements of the company. Assure that all contracts are in compliance with the operational, quality, and legal requirements of Fallon, MassHealth, CMS, and Division of Insurance as applicable
    • Serve as key resource for Fallon leadership in formulating and modifying strategic goals and planning related to provider APM strategies and contracts
    • Anticipate and meet, or exceed, internal and/or external customer expectations and requirements
    • Create efficient processes to assure that information flows freely and is accessible to all levels
    • Develop and execute policies, procedures and metrics for measuring success
    • Effectively manage budget and all resources for short and long term needs
    • Excellent leadership and management skills and experience


    • Bachelor’s Degree in a related field or the equivalent combination of training and experience; Master’s degree preferred
    • 10 years of managed care experience in contracting or provider network management
    • 2 years of progressively responsible management experience
    • 3 years of experience with risk contracting in a managed care or ACO environment
    • Experience working with Medicaid and other governmental and commercial products in both FFS and/or risk arrangements
    • Proven leadership skills in a managed care environment
    • Efficient decision making with the ability to successfully manage conflict
    • Consistently thinks and acts as a business lead. Sets challenging and far reaching standards and negotiates or works to adjust systems.
    • Excellent interpersonal skills with the ability to influence people to achieve organizational objectives



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