Director, Managed Care Contracting
About The Position
Under the direction of the Vice President, Managed Care, the Director, Managed Care Contracting support the managed care contracting initiatives including but not limited to directing re) negotiating and implementing managed care agreements for the facilities, affiliates, physicians and bundle arrangements within the health system. The incumbent will provide negotiation of contract rates and terms, language implementation and ensure contracts are standardized in accordance with the health systems established contracting parameters. This is a Hybrid position - requirement will be one day a week in the office
Requirements
- BA or BS required.
- Five to ten years equivalent healthcare experience.
- Network Management, managed care contracting experience.
- Excellent written and verbal communication skills.
- Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
Nice To Haves
- Master's degree.
- Risk contracting, and risk contract management experience
Responsibilities
- Directs the negotiations of assigned hospital, ancillary, physician and bundle agreements.
- Create and manage adherence to contract language and financial performance standards. Act as lead negotiator is certain key payer negotiations. Works within the guidelines outlined in the health system's contracting parameters to develop contracting strategies, evaluate the current performance of managed care and population health contracts, assist in forming the model to evaluate and proposals or counter proposals received or sent to payers; evaluate impact of reimbursement rates and/or methodologies.
- Establish and/or negotiate bundle agreements for specific service lines.
- Provides staff awareness and education on contract parameters and changes.
- Coordinates with Managed Care and Population Health teams to plan and implement strategy for facilities, ancillary and physician providers networks, including action plans for to obtain budget objectives.
- Ensure that relationships with payers and internal matrix partners are maintained at a high level.
- Coordinate the financial reporting and integrity supporting the management and measurement of proposed and implemented health system agreements.
- Leverage historical utilization data and predictive modeling to execute strategies. Engage with Analytics to develop reimbursement benchmarks and identify payment opportunities while streamlining contract performance.
- Team committed solid interpersonal communication skills.
- Other duties and/or projects as assigned.
- Adheres to HMH Organizational competencies and standards of behavior.
Benefits
- health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Director
