The System Director of Managed Care will serve as the managed care point person for certain Region(s) as Regional Subject Matter Expert (SME), while having System-wide accountability for numerous National Payers as assigned by senior leadership. Working with both corporate and regional staffs ensures the accurate negotiation, implementation, administration and ongoing monitoring of managed care contracts and corresponding processes and procedures at the System and Regional level.
Will have accountability to negotiate System managed care contracts and corresponding processes and procedures at the System level. May negotiate managed care contracts with regional payors as assigned by the System VP, Chief Managed Care Officer. Will lead System negotiating team as assigned.
Will work with System clinical quality department on quality metrics negotiated in contracts, which will impact future reimbursement. Will be accountable to work with System and Local Population Health and Clinical Integration staff to negotiate, implement, and monitor CIN and ACO managed care contracts. Position also has responsibility for physician related business development activity as assigned by VP, Chief Managed Care Officer and may include the recruitment of Regional CIN/ACO participants.
A high degree of professionalism is required due to the interaction, both written and verbal, with both internal (regional) and external (payor) contracts.
BS in business administration or like degree with strong preference for Master’s degree in Health Services Administration or MBA.
At least seven years of experience in health care or insurance organizations with experience in contract negotiation, physician interaction and network development. At least seven years of management experience with a minimum of two direct reports. At least seven years of experience leading large system negotiations in excess of $450M.
Excellent written and oral communication skills. Excellent organizational skills. Excellent training skills.
Knowledge of hospital, physician, and ambulatory contract modeling as well as reimbursement methodologies. Major
Accountable to lead System negotiating team for numerous system-wide and state level payor contracts. Accountable to coordinate regional CIN/ACO managed care contracting initiatives Accountable to lead System Managed Care Worker’s Compensation payor contract. Responsible for physician related business development activities as assigned by Vice President Managed Care (e.g. mergers, acquisitions, transactions with business development team).