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Director of Managed Care
4 months ago
Must Haves:
- 5-7 years of experience within an Academic Medical Center, Multi-hospital Health system, or Managed Care Organization company
- Direct experience leading the negotiating and management of complex care contracts
- Experience negotiating and managing all managed care contracts with third party payers and stakeholders
- 3 years of experience managing and negotiating Acute Care Contracts, Valued Based Contracts, and Physician based contracts (negotiations, modeling, and proposals)
- Strong knowledge and experience of how/why hospital reimbursements occur and how to build that into their negotiation strategy
- Experience managing a small team/strong leadership skills
- Strong knowledge of billing/coding terminology (ICD-10, CPT, Revenue Codes)
Plusses:
- Experience with Epic
- Experience with Access
- Experience with FinThrive
Day to Day:
A university hospital system is looking for a Director of Managed Care Contracting in the Oklahoma City area. This person will be responsible for the day-to-day operations of the Managed Care Department. This person will be responsible for negotiating and managing managed care agreements on behalf of the hospitals and physicians and with third party payers. The Director will also analyze, negotiate, and implement new and renegotiated managed care agreements for the health system while also creating strategies. This person will need strong experience within hospital reimbursements, modeling and proposing managed care contracts, acute care, as well as valued based contracts. They will also have one direct reports that they will be responsible for managing.
Job Responsibilities:
- Negotiate and manage all managed care contracts with third party payers in consultation with stakeholders
- Supervise, coach and mentor Manager, Managed Care Contracting
- Build and maintain positive ongoing relationships with all third- party payers with the objective of maximizing market share and revenues for hospitals and physicians.
- Work closely with SVP, Managed Care and senior leadership to devise payer strategies that align with organizational goals including market access and financial strength. This includes evaluation and initiation of new managed care contract opportunities, business models and payers' relationships.
- Advance organization's contracting and reimbursement strategy through optimization of existing contracts and development of new reimbursement models and innovation alternative payment models (APM)
- In conjunction with the Director, Managed Care Analytics, develop financial models to analyze payer proposals, evaluate risk exposure and assess potential upside and downside opportunities.
- Coordinate feedback and approval of contracts including financial risks and rewards from stakeholders.
- Negotiate contract language and performance terms. This includes legal, compliance, quality measures, reporting and data exchange requirements.
- Lead implementation and coordination of new contracts
- Establish, facilitate and participate in Payer joint operating committee (JOC) meetings.
- Work closely with support departments to develop, communicate and disseminate orientation educational materials to inform and educate key stakeholders regarding contract and performance terms, reporting tools and resources and market trends.
- Develop and maintain contract summaries including performance targets and measures matrix, timelines, contract requirements and deadlines.
- Owner of Contract Information System and other tools.
- Monitor and manage payer compliance issues including rosters, assignment, reports, delivery dates, fees, audits.
- Monitor and analyze changes in payer programs and policies that may affect contract performance and initiate negotiations as warranted.
- Revenue Cycle support including negotiation of claims settlements and single case agreements (SCAs)
- Participate in and report to various governing bodies including the Finance and Audit committee; support for these meetings and assist with contract material preparation and presentation.
- Create strategic alliances with internal and external groups to maximize payer relations and contract performance.
- Work with Manager, Managed Care to coordinate any credentialing/provider enrollment or request for information (RFI's) requirements for new contracts and initiatives.
- Supervise Manager, Managed Care Contracting Manager. Set objectives, review performance, conduct staff professional development, and provide guidance in accordance with department objectives, policies, and procedures. Facilitate staff recruitment, retention, and onboarding/orientation.
Compensation:
This position is targeting a salary range of $160k- $210k for this full time position.
