Director, Managed Care Contracting

OUR CLIENT is a well established Region Healthcare provider who services growing regions, rural communities and small towns.

IN THIS ROLE: As the Director, Managed Care Contracting

You are in a high visibility leader expected to take a leadership role administering, coordinating and negotiating on their behalf in their respective Group, Region or Market.

Provide oversight or direct negotiating in all Managed Care negotiation and contracting activities consistent with the Managed Care strategies, business and financial plans.

Develop contracting strategies for governmental contracts to ensure best possible outcomes for Client facilities.

Lead significant dollar and volume contracts negotiations, and oversee proper supporting Managed Care Data, Information, and Financial Systems to be provided in the formats to align with strategic and operational insights required for a beneficial negotiation.

Negotiate contracts with Managed Care payers and governmental entities on behalf of all Client facilities including legal language review, proposal of rates, reimbursement methodologies, and review of any state regulations or federal regulations.

Direct and provide financial analysis to support contracting efforts and issue resolution to include the use of PIC forecaster Models, Excel Models and other tools available to assess contracts or revenue recovery opportunities

Analyze and monitor financial and operational aspects of existing Managed Care Contracts for use in making recommendations on renewals, re-negotiations or terminations.

Cultivate and maintain professional relationships with all third parties and/or vendors to promote proactive problem resolution.

Research state and federal regulations as they change for payers and educate Client Health Support Center (HSC) departments and facilities on the impacts of these changes to reimbursement and processes.

Manage the implementation of completed contracts including dissemination of the contract to relevant parties, explanations of new items in the contract, ensure contract has been scanned, filed and logged in Client files

TO SUCCEED IN THIS ROLE, YOU HAVE:

Bachelor's Degree in Business, Accounting, Finance or Healthcare Management

Minimum of 10 years in Hospital or Health Plan experience with knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.