Chief Managed Care Officer

6 days ago

Charleston, United States Roper St. Francis Healthcare Full time

Primary Function/General Purpose of Position

Manages the overall operations of managed care including managed care contract negotiations, analysis, and compliance activities in support of the managed care strategies, business and financial plans. Develops strategy to support the growth of the system. Ensures the negotiation of appropriate contract rates within established deadlines and financial targets. Provides our organization with accurate and current managed care market intelligence. Conducts competitive market assessments. Applies assessment results, regulatory changes, and impact of payor initiatives to support our organization’s goals and initiatives. Oversees the development and delivery of standard contract metrics, reporting frequency and delivery of reports to measure performance.


Essential Job Functions

  • Provides leadership direction and executive accountability for managed care contracting and network management initiatives with commercial and governmental third-party payers in support of our organization’s strategic plan. Active monitoring of internal and external managed care environment. Identifying managed care market, net revenue, volume, and cost trends and establishing specific action plans to track and trend issues related to overall contract performance.
  • Responsible for providing support and guidance to all areas of our organizations on contract management issues/interpretation of terms. Enforce or report to leadership, as appropriate, issues related to Managed Care payer compliance with contractual payment terms. Develops and implements financial parameters and managed care reimbursement methodologies in support of value based contracting opportunities aligned with the strategic plan. Provides executive oversight for managed care contract performance and compliance with contractual terms and provisions.
  • Oversight of processes related to managed care analytics, reporting and the managed care contract management system.
  • Provide leadership and support to staff and evaluate/develop processes, policies, and procedures for the Managed Care Department, as applicable.
  • Monitoring contract anniversary dates; creation of contract negotiation packets including pertinent market and contract performance data. Developing recommendations to managed care and senior leadership based on overall contract performance. Ensuring existing and new contracts conform to all pertinent language requirements from an operational and legal perspective.


This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.


Education

  • Bachelor’s degree in accounting, finance, or related field.
  • Master’s degree in business or healthcare administration preferred.


Work Experience

  • Five years of provider experience as a contract negotiator.
  • Payor or healthcare system experience.

Skills

  • Knowledge of local, regional, and national trends.
  • Ability to manage and operate department within budgetary guidelines.
  • Skilled in leading, directing, coordinating work of managed care staff to ensure complete and accurate records of our organization’s assets, liabilities, and financial transactions.
  • Must possess skills necessary to perform ongoing monitoring of financial performance of departments within the system, with understanding of internal and external factors affecting that performance to question and resolve variance issues.
  • Ability to identify process improvements, develop new process/procedures to improve quality, efficiency, customer service and carry through to completion.
  • Ability to research highly complex managed care issues to solve problems and form appropriate conclusions.
  • Strong written and verbal communications skills and ability to prepare, analyze and interpret information. Ability to exercise good judgment in areas of high complexity when the situation warrants.
  • Keep up with relevant industry and managed care developments to provide guidance and technical support to staff.



Roper St. Francis Healthcare is an equal opportunity employer.

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