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Associate Director Managed Care Contracting

3 months ago

Durham, United States Duke University Full time
About Duke University and Health System

Tracing its origins to 1838, Duke University has evolved into one of the world's leading institutions for education, research and patient care. Located in Durham, North Carolina, Duke is comprised of two major organizations: Duke University and Duke University Health System.

Duke University Health System is a world-class health care network dedicated to providing outstanding patient care, educating tomorrow's health care leaders, and discovering new and better ways to treat disease through biomedical research.

General Description of the Job Class

Has primary responsibility for identifying prospective managed care contracts, negotiation, and rate determination for the Duke University Health System, Inc. (includes 3 hospitals, 2 ambulatory surgery centers, 7 retail pharmacies, 4 employed physician groups (2000+ total providers), home health, home infusion, and hospice). Oversees the data collection function for both prospective contracts and current contracts and assists in the analysis of that data. Initiates the renewal process as appropriate. Performs these functions by establishing policy and procedure. Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts.

Duties and Responsibilities of this Level
  • Responsible for the development and management of negotiations for managed care contracts in a manner consistent with the Health System's strategic approach to managed care, including:
  • Evaluation of new contracting opportunities, including substantive and pricing components, for the Health System.
  • Management of financial, operational, and legal analysis of proposed managed care agreements.
  • Serve as the primary negotiator in managed care negotiations. Negotiates contract rates and language provisions in accordance with established Health System policy and procedure.
  • Assist in the development of the necessary systems to support the data and analysis needs of managed care contracting.
  • Responsible for assisting in the implementation of payer and value-based contracts, including:
  • Coordinate with the Patient Revenue Management Organization and the Population Health Management Office the contract implementation process for appropriate internal audiences, including hospital and professional administrative and professional staffs.
  • Identify and recommend appropriate changes in operating procedures and systems that might be required to accommodate a managed care contract.
  • Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts.
  • Responsible for monitoring the performance of managed care agreements, including:
  • Development and maintenance of quarterly management reports for Health System senior management analyzing managed care activities, contract trends, costs and profitability.
  • Monitor managed care companies??? compliance with contractual requirements of the managed care agreements. Responds quickly and effectively to negative trends.
  • Evaluate existing agreements and report findings/recommendations to renegotiate/modify/terminate contractual relationships to Assistant Vice President, Managed Care.
  • Meet with plan representatives to discuss ways to strengthen existing relations.
  • Responsible for assisting the Assistant Vice President, Managed Care in developing the strategic managed care plan for the Health System, including:
  • Serve as a liaison to Health System's Clinical Service Lines in the strategic planning process.
  • Interact with all Health System components in the development and implementation of managed care initiatives.
  • Responsible for representing the Health System to external audiences at conferences, presentations, workshops, association meetings, community events, etc., including:
  • Represent the Health System to managed care entities in day-to-day customer service relations.
  • Performs other assigned responsibilities and projects as delegated by the Assistant Vice President, Managed Care.
  • Develops and implements a personal development program to ensure continuing professional growth.


Minimum Qualifications

Education

Bachelor's degree in Business Administration, Health Care Management or related field. MBA and/or MHA highly desirable

Experience

5 years of hospital, physician, and alternate site managed care contracting experience for commercial, Medicare, and Medicaid.

Job Code: 00005239 ASSOC DIRECTOR, MANAGED CARE
Job Level: I2

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiringdepartment.