Director of Managed Care

Position Overview

The Director - Managed Care is responsible for negotiating, administering, coordinating and overseeing managed care agreements that improve, enhance and maximize health system managed care and value-based revenues and payer performance. This role coordinates the development, implementation and on-going monitoring of managed care and value-based agreements. This position develops and maintains relationships with managed care payers, insurance companies, brokers/consultants, Third Party Administrators (TPAs) and employers. This person analyzes the revenues and costs of each payers' activities and performance, and produces the "Payer Scorecard", sharing the results, including insights and recommendations with the Payer Contracting team, Health System Finance and key executives. Additionally, this role manages and maintains the contract inventory and Payer matrix, and insures the appropriate administration and storage for all related contracts and documents in an organized and manageable fashion. This position will work in collaboration with the Vice President - Managed Care to direct and implement programs designed to foster positive relations and growth opportunities between the Health System and businesses in order to establish partnerships and affiliations. This position will utilize the system's resources to strengthen relationships and generate revenues and "good will" for the system. The Director maintains ongoing communications with payers, employers and brokers to understand needs and offer creative solutions to their problems. The Director - Managed Care accepts comments, suggestions, and complaints and utilizes the outreach problem solving process to assure timely response and resolution of identified opportunities and issues.

Job Specific Essential Functions

In concert with the VP Managed Care, responsible for initiating and conducting payer negotiations to ensure long-term financial viability for the organization.

Negotiates financial rates, updates agreements with current contract language meeting the needs of both the system and the third-party payer and evaluates and negotiates value-based programs.

Reviews opportunities and negotiates risk-based agreements that will benefit the health system.

Utilizes system resources and reports to evaluate contract rates, payment practices and payer performance (Payer Scorecards, etc.).

Possesses strong organizational skills and ability to manage multiple projects simultaneously.

Strong interpersonal skills and ability to develop and nurture effective working relationships with internal and external customers and partners.

In coordination with VP Managed Care, provide assistance and support for long-range financial planning, direct to employer strategy and growth of the organization's "High Performance Health Network."

This position works to develop relationships with commercial payers and understands how specific contracts economically impact all communities served by the health system.

Gathers compliments, complaints, and suggestions for improvement for the Health System and communicates these to appropriate individuals within the system.

Promotes services and physicians throughout the business and payer communities.

Provides continuous market information regarding competitor actions and trends in the business and payer communities to support/validate market research and strategies market opportunities.

Professional Requirements

Bachelor's Degree in Business, Health Administration or related field; Master's degree preferred

3-5 years diverse healthcare experience in a professional capacity with at least 2 years of Payer contracting for health services and value-based care

The successful candidate will be able to process and understand healthcare and insurance information and convey that information in a concise, compelling, and persuasive manner to health system leaders, managed care companies, area business leaders and influential insurance brokers.

Must have excellent written and oral communication skills, planning and organizational experience.

Must maintain the highest levels of integrity and confidentiality, and have a thorough understanding of legal, business and insurance operations and principles.

Permanent