Associate Director of Managed Care

Four Winds Inc. • Town of Bedford, NY

13h • $70,000 - $75,000

About The Position

Four Winds Hospital, a leading provider of psychiatric inpatient services that treats children adolescents and adults, is seeking an Associate Director of Managed Care. The Director of Managed Care is responsible for maximizing Managed Care Organization payments, decreasing denial rates and working with Four Winds Senior Management to develop efficient authorization workflows.

Four Winds offers a generous benefits package, which includes but not limited to:

Generous vacation & holiday package
Employer funded pension plan
401k (contributory)
Medical, Vision and Dental Insurance (contributory)
Pet Insurance
Life insurance at no cost to the employee
Flexible spending plan for both healthcare and dependent care expenses, and more

Requirements

• Bachelor’s Degree required, or equivalent combination of education and related experience.
• 5+ years of managed care experience required.
• Management experience/leadership experience particularly leading change through multidisciplinary teams.
• Ability to conform to shifting priorities, demands and timelines.
• Knowledge of NYS Medicaid and Medicare.
• Knowledge of Managed Care Organizations.

Nice To Haves

• Master’s Degree preferred.

Responsibilities

• Ensures correct insurance and authorization information is entered into patient record in a timely manner.
• Coordinates closely with admissions to ensure patients admitted to FWH programs have correct benefits.
• Identifies incoming patients whom have outstanding balances, or will owe deductible and negotiate payment plan.
• Develops and maintains MCO relationships to improve issue resolution, set up regular meetings if needed.
• Identifies trends/patterns that increase denial rates and address internally and with MCOs.
• Coordinates the appeal process and track status of appeals. .
• Responsible for UR reports, monthly County reports for Westchester and Dutchess Counties, and quarterly COPS report.
• Completes yearly contracting and credentialing needs with each MCO
• Orients new clinical hires in regards to Utilization Review including LMSW, LCSW, LMHC, PMHNP and MD.
• Assists clinical staff with discharge disposition issues as it relates to Utilization Management
• Negotiates rates of increase on a yearly basis
• Performs related duties as required.

Benefits

• Generous vacation & holiday package
• Employer funded pension plan
• 401k (contributory)
• Medical, Vision and Dental Insurance (contributory)
• Pet Insurance
• Life insurance at no cost to the employee
• Flexible spending plan for both healthcare and dependent care expenses, and more

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 101-250 employees