Dir. Managed Care
4 months ago
Job Summary:
The Director of Managed Care provides strategic and operation expertise in negotiating managed care contracts. Models and analyzes managed care contracts for potential opportunities and collaboratively works with managed care plans to execute Managed Care agreements for the organization. Performs analyses to track identified opportunities through contract negotiations and execution. Identifies and coordinates Medicare business development opportunities in collaboration with strategic business plan. Cultivates and manages positive working relationships with managed care plans. Advocates to Medicare and Medicare Advantage eligible population in the education of hospital services available.
Minimum Requirements:
Work Experience:
Five years of related experience in Managed Care Contracting required.
Five years of management experience required.
License/Registration/Certificate:
None
Education and Training:
Bachelor’s Degree in Business Administration or a health related field required, Master’s degree preferred.
Skills:
- Excellent analytical skills, negotiation skills and knowledge of reimbursement methodologies.
- Knowledge and understanding of healthcare industry and government reimbursement methodologies including Medicare and Medicaid.
- Posses detailed understanding of Financial aspects of rates of return and break-even points, as applied to specific business models at the organizational level, or service line.
- Ability to adapt to and use information system tools available to fulfill job requirements
- Leadership ability, communications, and interpersonal skills necessary to interact effectively with physicians, management, staff, external agencies/customers and patients/families.
- Astute organization and contract management skills.
- Ability to collect/analyze data to communicate and negotiate terms and provision related to hospital, physician and clinic contracts with insurance companies and other third parties. Knowledgeable on Medicare benefits, regulations, and all associated, relevant Medicare data.
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