Dir, Health Plans

The Director, Health Plans will manage the relationship with Humana and Humana Military health plan organizations.  S/he will have overall leadership responsibility for the Health Plans assigned book of business including: Health Plan Partner Relationship Management, Contract Negotiation, Health Plan Account and Market Strategy Development and Execution.  The Director will lead and drive health plan sales strategies in collaboration with Regional Commercial Sales Leaders and Staff to leverage access to local, regional and national health plan customers to drive compelling physician, health plan payor and patient preference and utilization. The Director will report directly to the Executive Director, Health Plans – National Accounts and location for the role is flexible.

• Develop and Champion Health Plan Growth Strategies and Tactics
• Achieve annual budgeted goals related to requisitions and revenue
• Lead, guide and collaborate with dotted-line National Health Plans Account Manager to optimize execution of strategies, account and relationship management and contract performance
• Collaborate with Senior Leadership, Medical Affairs, Emerging Markets/Enterprise Account Leaders, Marketing, Finance, Legal, Billing, Commercial Sales and Operations and other stakeholders in a matrixed business environment
• Sell Quest value, negotiate, coordinate and lead overall Health Plan relationship to secure contracts with favorable terms such as value-based / shared savings arrangements
• Develop, coordinate and leverage multi-level and multi-functional relationships with health plan customers to assure preferential positioning and relationships
• Advance the company’s agenda on complex Medicare Advantage and Managed Medicaid regulatory and payor issues, such as MA Organization Determinations, Medical Necessity and Prior Authorization requirements
• Identify and execute on opportunities and solutions to build customer value and drive Quest growth through design, promotion and execution of programs supporting Lab Spend Management, Improved Patient Care, Information Technology, Increased Efficiency and Customer Satisfaction, Improved Reimbursement, Patient Volume and Margins 
• Drive Collaborative Selling Opportunities including Diagnostic Solutions products and programs such as Wellness Programs, Gaps in Care initiatives, HEDIS / STARS improvement Programs, Healthcare Analytic Solutions products, etc.
• Sell/negotiate, promote and execute on Marketing Programs, coverage and reimbursement for new tests, coverage policies, services and improved reimbursement for targeted tests
• Commercial Sales Strategies and Execution; Coach and mentor to effectively drive results
• Develop, Lead and or participate with health plan, national accounts, regional and cross functional teams and external customer teams
• Drive implementation and execution of existing and new contracts
• Develop and build account and business strategies for internal and external reviews
• Influence and leverage internal and external business partners
• Demonstrate assertive and professional negotiation of contracts, terms and conditions that positions Quest in alignment with leadership approvals
• Successfully collaborate with Regional Health Plan Teams to ensure customer and company requirements are met

Required Work Experience: 

5+ years direct sales, negotiation, complex customer, consulting and/or contracting experience in the health care industry

Preferred Work Experience: 

Experience working with Medicare Advantage and Tricare health plans and policy

Clinical laboratory third party coverage, reimbursement and claims processing experience

Physical and Mental Requirements: 

Long periods sitting, working at computer, paying attention to detail

Knowledge: 

Strong knowledge of Health Plan/Insurance/Healthcare marketplace

Understands the principles of Consultative Selling; meets customer’s needs

Understands and has utilized a sales process and strategic account management model

Knowledgeable of compliant billing practices for Medicare Advantage and Managed Medicaid

Experience with payvider model

Working understanding of delegated risk, capitation and other compensation models

Skills: 

Ability/Agility to Impact and Influence others

Excellent communications skills—written, verbal and presentation

Proven ability to sell in a dynamic, competitive environment

Drives results with Passion and Integrity

Skilled at negotiation and has a demonstrated ability to build relationships at the C Suite level

Balances customer needs with Quest’s organizational and profitability goals

Performs well in a team environment

Viewed as a credible business consultant versus transactional salesperson

Displays Courage, Energy and Drive and has the Operating Skills to drive results

Track record of overall business and financial acumen

EDUCATION

Bachelor’s Degree (Required)

Master’s Degree

LICENSECERTIFICATIONS

Driver's License (Required)

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets