Director of Managed Care Contracting

3 days ago

Gainesville, FL, United States UF Health Full time
Overview

The Director, Contracting & Operations is responsible for providing guidance and leadership to the Managed Care Account Management and Population Care Management teams for the Gainesville campus. Responsible for direct oversite of Managers, Analysts, Coordinators, Systems Specialists, and others who may function in an Assistant capacity, including those that manage provider enrollment, websites, case agreements, and newsletter processes.

Responsibilities

  • Responsible to interface with other operational areas and build strategic relationships between ones' area and other areas.
  • Responsible for managed care contracting, including but not limited to value based and pay for performance contracting, and population health initiatives to position SUFHCN (hospitals, ancillary facilities, and UF and Shands physicians and providers) as a major referral institution for the state of Florida, and as the dominant health care provider within its local service area and surrounding core counties.
  • Also responsible for ensuring the operational efficiency of existing contracts. The Director, Contracting & Operations, works with the Assoc. Vice President of Managed Care in determining payor contracting strategies, negotiating contracts, policy development, departmental goals, and planning.
  • The Director also prioritizes and directs the workload of staff and initiating and coordinating contract negotiations activity across functional areas (legal, pricing analysis, billing and AR, UF clinics and hospital operations, physicians and other providers, network management and contract management) to ensure contract implementation, execution, and improved contract operational and financial performance.
Qualifications
  • Requires a BS or BA degree in business or health care field and 5 to 7 years of experience in managed care industry - whether payor or provider-related, with direct supervisory experience.
  • In lieu of a BS or BA degree, the candidate must have an AA degree and 7 to 9 years of experience, or a high school diploma with 9 to 10 years of experience.
  • Must have experience with contract review and financial negotiation and knowledge of financial analysis methods (including payor and provider pricing, actuarial risk analysis, and premium development), claims management, utilization review management, benefit plan management, and financial and accounts receivable report management.
  • Must have experience in managing projects and work product of other professional-level personnel.

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