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Director of Managed Care
2 months ago
Job Description
About the job
HME Specialists is a fast-growing primary player in NM providing Durable Medical Equipment, Home Infusion, and LTC/Hospice services. The Director of Managed Care & Contracting will oversee strategy and development for all Managed Care Services and Contracting for the LTC and New Vista lines of business. The Corporate Director is responsible for full managed care contract life-cycle support, including new business and revenue development through continued clinical integration and market expansion.
Job duties & responsibilities
Develop, negotiate, and implement new and ongoing payer strategies, models, and partnerships that support HME revenue and margin growth.
Proactively identify and engage target payors who are candidates for innovative partnerships that maximize HME Specialists' ability to provide services to all patients regardless of insurance.
Deliver improved payor satisfaction through the execution of strategic programs and assisting in reporting on patient care to managed care partners.
Lead and maintain credentialing, re-credentialing, reimbursement, and contracted entities updates.
Assist with claims escalation processes with payer partners.
Lead and assist with RFPs.
Support and educate Case Management.
Serve as a subject matter expert on contract and reimbursement-related issues impacting our industry and healthcare industries, particularly with a managed care and commercial reimbursement focus.
Knowledge/Skills/Abilities
The qualified candidate will have extensive knowledge and relevant work experience in the Managed Care/insurance sectors including network planning/development, contract negotiations, etc.
Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies.
This position reports to the VP of Sales and Business Development.
Experience
Experience in Managed Care contracting for a multi-site Ancillary Healthcare Provider desired.
2 years of healthcare contracting experience required.
Bachelor's degree preferred.
Experience with Medicare Licensure preferred.
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