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Director of Managed Care Contracting

2 months ago

Nashville, Tennessee, United States Newport Healthcare Full time

About Us

Newport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. Our team of experts is committed to transforming lives through evidence-based treatment, and we're seeking a skilled professional to join our leadership team.

Key Responsibilities

  • Lead the development and implementation of managed care contracts across the enterprise, ensuring strong relationships with payors and effective contract negotiation and implementation.
  • Design and execute innovative contracting models, including value-based and pay-for-performance reimbursement models, to drive business growth and improve patient outcomes.
  • Oversee the management of payor relationships, including contract administration, revenue cycle management, and network development.
  • Collaborate with cross-functional teams to identify and address business opportunities and challenges, and develop strategic plans to drive business growth.
  • Develop and maintain a thorough understanding of payor contract language, regulatory requirements, and industry trends.
  • Monitor contract performance and identify opportunities for improvement, and develop and implement corrective actions as needed.
  • Provide leadership and guidance to direct reports, and develop and implement training programs to ensure team members have the skills and knowledge needed to succeed in their roles.

Requirements

  • Bachelor's degree in business or a related field, with a master's degree preferred.
  • 10+ years of full-time professional experience in managed care contracting, with 5+ years in a leadership role.
  • Experience leading payor relations for a multi-state healthcare services organization, with a focus on behavioral health.
  • Demonstrated knowledge and ability to analyze payor contracts, provider manuals, reimbursement methodologies, and rates.
  • Significant knowledge of contractual, administrative, health insurance, and operational issues related to managed care organizations, healthcare providers, and health insurance benefit plan designs.
  • Proficiency with Microsoft Office, Google Suite, CRM, and video conferencing technologies.
  • Exceptional interpersonal, relationship-building, and listening skills, with a natural, consultative style.
  • Expert in advising, presenting to, and persuading senior leaders.