Director - Managed Care Contracting & Development

1 month ago

Baton Rouge, United States Baton Rouge General Full time

Responsible to lead development and execution of the Managed Care strategy, including all managed care related payor relations initiatives. Will serve as a key leader and critical liaison between the managed care payers and General Health System operations and other support services (Operations Leadership, Case Management, Sales and Marketing, Business Office, Finance, etc.). Collaborates with market colleagues to identify and execute on business development, revenue growth opportunities, systematic clinical and/or operational issues with managed care or 3rd party payors. This position is both internal and external facing, develops and maintains effective working relationships with key stakeholders with managed care payers in the market. Executes on business development opportunities by focusing on General Health System's value proposition and drives increased managed care penetration across the continuum of care.

Develops and updates the Managed Care Strategy in collaboration with Operational leadership and the Managed Care Steering Committee, including documentation of goals, activities, and progress achieved.

· Determine the optimal allocation of necessary resources to effectively manage the relationships with payers in the market, including provider organizations under a contractual or risk-bearing agreements include value-based agreements

· Builds and maintains managed care payer relationships in support of the Managed Care strategy to ensure (i) appropriate contact and communication at all necessary levels within the payor organization (e.g. contracting, medical management, discharge planning, etc.), (ii) communication of General Health System's value proposition (iii) resolving “barriers to entry”, and (iv) consistency of messaging in general

· Owns and manages all aspects of assigned portfolio of managed care and associated payor relationships, including (i) identifying opportunities to grow our managed care business and scheduling meetings with the relevant payer contacts, (ii) creating tailored presentations / materials, (iii) seeking preparation and attendance support from appropriate internal colleagues, as necessary, and (iv) leading payor meetings

· Sponsors and holds quarterly Joint Operating/Quality Committee (JOC/JQC) meetings with managed care payer leadership and key decision-makers to identify and pursue business growth opportunities, resolve key clinical and/or operational issues, etc.

· Sponsors quarterly cross-divisional, cross-functional Managed Care meetings (a forum for communication between the market's key internal constituents) to assess key managed care trends, and to inform and adjust market-based managed care strategies and contract initiatives, as necessary

· Educate core group of market operators and other internal support services (e.g. Business Office, Admission, Sales & Marketing, Medical Management, etc.) on relevant elements of new or renegotiated contracts

· Updates and maintains payor-specific activity for assigned accounts

· Documents critical reporting capabilities for General Health System based on payors' evolving data needs, as identified in JQC and other meetings



Requirements

Job Requirement

Minimum of 5-7 years in the healthcare industry dealing directly with managed care activity, contract development or other consulting/public experience.

3 to 5 years' experience directly related to the job duties noted in the job description.

Experience in hospital administration or management with significant involvement with medical staff, patient relations, and incident management.

Education Requirements:

Bachelor's degree in Business Administration, Nursing, Law or paralegal or related field

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