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NSGC Job Opportunity: Payer Relationship Consultant 

Estimated Time Year 1:  0.5 FTE months 1-6; 0.2 FTE months 7-12

Estimated Time Year 2 and Subsequent Years: 0.2 FTE

Email CV and statement of interest and/or questions to: Meghan Carey, Executive Director, NSGC mcarey@nsgc.org ATTN: NSGC Payer Relationship Consultant

The National Society of Genetic Counselors (NSGC) is seeking a part-time Payer Relationship Consultant to provide strategy, ongoing engagement, responsiveness, project management and specialized expertise in the establishment and ongoing cultivation of relationships with large national payers and development of effective payer polices. Additionally, the Payer Relationship Consultant will provide managerial direction, leadership, consultation, project management and expertise for expansion of access to and reimbursement of services provided by genetic counselors for major national Managed Care payers. The successful candidate will provide strategic leadership in negotiating effective genetic counselor policy with HMO, PPO and other major payer contracting entities. Work assignments involve critical relationship, collaborative and consensus-building while managing relationships between payers, NSGC, and its members. Preferred experience in in-depth knowledge of genetic counseling service delivery, genetic services, managed care contracting and payer-provider relationships. The Payer Relationship Consultant will serve as a subject matter expert by providing policy guidance and problem/issue resolution to NSGC members on matters affecting service delivery. Some travel is required.

ESSENTIAL FUNCTIONS

  1. Knows, understands, incorporates, and demonstrates the mission, vision, and values of NSGC in leadership behaviors, practices, and decisions.
  2. Leads activities in relationship building and management, strategy development, project management, network development, payer collaboration, and policy.
  3. Conducts policy analysis with major payers. Secures implementation of access and reimbursement objectives thorough project management and negotiations.
  4. Serves as a subject matter expert by providing education and guidance to NSGC members.

Maintains a working knowledge of applicable Federal and State laws/regulations; the NSGC Code of Ethics; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

DESIRABLE QUALIFICATIONS

1. Master’s Degree in Genetic Counseling or Human Genetics preferred; Bachelor's degree in Business Administration, Finance, Accounting, Informatics or related field or an equivalent combination of education and related experience preferred. Requires a breadth and mastery of technical and business knowledge in multiple disciplines/processes.

2. Significant industry experience and expertise with payer relations and Managed Care; specific experience related to reimbursement for genetic services preferred. (e.g., payer contracting, decision support, health information management, patient financial services).

3. Ability to manage multiple large multi-functional/interdisciplinary and highly visible projects having a broad scope of responsibility and impact. Demonstrated increases in operational or project management leadership experience.

5. Excellent leadership, analytical, organization, integration and executive skills and abilities.

6. Excellent interpersonal, consultative, relationship and consensus-building skills in order to effectively lead and participate as a member of multi-functional teams and develop collaborative partnerships with executive leaders, key stakeholders and decision makers.

7. Ability to influence results, garner support and tactfully manage complex relationships. Ability to read the subtle nuances of situations and react/plan accordingly.

8. Demonstrates superior oral and written communication skills. Ability to facilitate communications between diverse groups. Ability to effectively listen, identify, assess and facilitate improvements and solutions and present advisory and persuasive recommendations.

9. Must possess deep analytical, quantitative, evaluative, organizational, planning and problem solving skills.

10. Ability to work independently and with minimal supervision. Ability to work as a member of a collaborative, shared leadership team, involving both paid staff and volunteer leadership, providing support to multiple positions.

11. Demonstrated ability to respect confidential and sensitive information, understanding and honoring lines of accountability and communication is essential.

12. Ability to operate in an ambiguous and matrix organizational environment. Ability to operate in a highly autonomous self-directed manner and to respond effectively to multiple, ever­-changing competing priorities.

13. Must possess a personal presence characterized by a sense of honesty, integrity and caring with a commitment to promote the mission, vision, strategic goals, and values of NSGC.

ESSENTIAL FUNCTIONS AND/OR MINIMUM QUALIFICATIONS ALSO INCLUDE THE BELOW (PREFERRED).

Experience initiating, building and maintaining relationships with key stakeholders within health plans.

 

Health plan contracting and negotiation knowledge and experience.

 

Broad-based knowledge and experience of health care reimbursement operations.



PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

  1. Must be able to commit to a minimum of two years in the role.

 

  1. Must be able to set and organize own work: priorities, and adapt to them as they change frequently.

 

  1. Must establish clearly defined goals and timelines and submit regular reports to the NSGC Board of Directors against those goals.

 

  1. Must be track health plan contacts and relationships and staff the Payer Outreach Working Group of the ASD Payer Subcommittee.

 

  1. Must be able to travel to the NSGC Executive Office, NSGC Annual conference and various payer sites as needed.

 

  1. Must possess the ability to comply with NSGC policies and procedures.

 

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

 

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