Director, Managed Care (H)

University of Miami•Medley, FL

1d•Onsite

About The Position

The Director, Managed Care provides strategic and tactical support to leadership on the development of strategic partnerships with payers and affiliated provider organizations. The incumbent serves as a key tactician in maintaining and expanding UHealth’s competencies and investments in clinical specialties, robotics, satellite expansion, capital investments, and quality improvement initiatives, among others to ensure the organization is competitively positioned in partnership with key organizations for long term success. Focuses on volume growth, market share expansion, and strategic partnerships with payers, affiliated provider organizations, employers, and other healthcare stakeholders. Executes strategies and directs operations to protect and grow market position. Drafts and presents facts-and-projections-based presentations (i.e. storyboard) that help to attract potential partnerships with payers and affiliated provider organizations. Maintains current knowledge of community developments as it pertains to competitive issues in managed care Ensures major payers, regional hospitals, physician groups, and ancillary service providers consider UHealth the most valued partner in the south Florida market. Manages programmatic and business planning and development. Initiates, researches, and evaluates new business opportunities, including relationships, pricing models, services, operational structures, and network development opportunities. Develops and utilizes complex financial models to assess payer contracts, value-based arrangements, strategic partnerships, reimbursement methodologies, and new business opportunities. Directs financial analyses, reporting, performance monitoring, and cost-savings evaluations to support negotiations and business decisions. Develops and applies appropriate clinical, research and education metrics for the evaluation of business cases and programmatic activities and monitors strategic planning progress. Coordinates groups involved in the development of multi-disciplinary programs to support the most favorable proposition for the Health System as a whole. Initiates, conducts, and facilitates meetings with internal and external stakeholders to exchange information, resolve operational issues, develop strategic partnerships, evaluate new ventures, and support long-range planning initiatives. Serves as a liaison between internal and external stakeholders, managing communications, operational issues, strategic initiatives, and partnership opportunities. Coordinates efforts across departments and leadership teams to support organizational objectives. Develops business plan and integration strategies for community physician practices. Leads and manages staff responsible for network contracting, contract implementation and operations, non-participation agreements, provider roster management, reporting, and special projects. Oversees hiring, onboarding, training, mentoring, performance management, professional development, coaching, and disciplinary actions, as appropriate. Collaborates with internal peers and senior leaders, advising on medical economics and contract modeling, revenue cycle functions, audits and collections activities, and counsels medical department leadership on managed care protocols and strategy. Trains on new procedures, supplies, and pharmaceuticals being used for inclusion in the managed care contracting process. Oversees all stages of the hospital and physician managed care contracting process, including contract negotiation, implementation, operational readiness, payer communications, provider enrollment coordination, and ongoing contract performance monitoring. Executes and manages complex legal, financial, operational, and reimbursement contract negotiations with national, regional, government, and commercial payers. Develops and executes contracting strategies for all components of the health system, including hospital, physician, transplant, ancillary, specialty network, and other integrated healthcare services across fee-for-service and value-based reimbursement arrangements, including capitation, bundled payments, pay-for-performance, shared savings, shared risk, and full-risk agreements. Monitors and responds to insurance industry trends, healthcare reform initiatives, payer strategies, legislative and regulatory changes, payor policy modifications and competitive market dynamics to maintain and strengthen the organization's strategic position. Escalates, monitors, and manages payer operational issues identified through revenue cycle operations, Central Business Office activities, Joint Operations Committee meetings, and other governance structures. Collaborates with payer and organizational leadership to drive issue resolution and mitigate operational, financial, or legal risk. Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations. Creates an effective control environment, conducts risk assessment, implements, and monitors controls.

Requirements

Minimum 5 years of relevant experience required
Bachelor’s degree in relevant field required
Strategic Alignment: Skilled in aligning departmental goals with enterprise-wide strategy and develops comprehensive strategic plans.
Financial Management: Ensures fiscal responsibility, and optimization of financial performance.
Resource Management: Ability to allocate resources and drive innovation and growth.
Adaptability: Proven ability to adjust to changes and leads/inspires transformational change.
Team Leadership: Ability to build and lead high-performing teams, manage complex projects, and ensure successful project delivery.
Technology & Analytics: Understanding of technology, data analytics, and performance measurement to drive strategic decisions and identify opportunities.
Communication: Ability to influence others, articulate strategic vision, and ensure clear and persuasive communication.

Responsibilities

Provides strategic and tactical support to leadership on the development of strategic partnerships with payers and affiliated provider organizations.
Serves as a key tactician in maintaining and expanding UHealth’s competencies and investments in clinical specialties, robotics, satellite expansion, capital investments, and quality improvement initiatives.
Focuses on volume growth, market share expansion, and strategic partnerships with payers, affiliated provider organizations, employers, and other healthcare stakeholders.
Executes strategies and directs operations to protect and grow market position.
Drafts and presents facts-and-projections-based presentations that help to attract potential partnerships with payers and affiliated provider organizations.
Maintains current knowledge of community developments as it pertains to competitive issues in managed care.
Ensures major payers, regional hospitals, physician groups, and ancillary service providers consider UHealth the most valued partner in the south Florida market.
Manages programmatic and business planning and development.
Initiates, researches, and evaluates new business opportunities, including relationships, pricing models, services, operational structures, and network development opportunities.
Develops and utilizes complex financial models to assess payer contracts, value-based arrangements, strategic partnerships, reimbursement methodologies, and new business opportunities.
Directs financial analyses, reporting, performance monitoring, and cost-savings evaluations to support negotiations and business decisions.
Develops and applies appropriate clinical, research and education metrics for the evaluation of business cases and programmatic activities and monitors strategic planning progress.
Coordinates groups involved in the development of multi-disciplinary programs to support the most favorable proposition for the Health System as a whole.
Initiates, conducts, and facilitates meetings with internal and external stakeholders to exchange information, resolve operational issues, develop strategic partnerships, evaluate new ventures, and support long-range planning initiatives.
Serves as a liaison between internal and external stakeholders, managing communications, operational issues, strategic initiatives, and partnership opportunities.
Coordinates efforts across departments and leadership teams to support organizational objectives.
Develops business plan and integration strategies for community physician practices.
Leads and manages staff responsible for network contracting, contract implementation and operations, non-participation agreements, provider roster management, reporting, and special projects.
Oversees hiring, onboarding, training, mentoring, performance management, professional development, coaching, and disciplinary actions, as appropriate.
Collaborates with internal peers and senior leaders, advising on medical economics and contract modeling, revenue cycle functions, audits and collections activities, and counsels medical department leadership on managed care protocols and strategy.
Trains on new procedures, supplies, and pharmaceuticals being used for inclusion in the managed care contracting process.
Oversees all stages of the hospital and physician managed care contracting process, including contract negotiation, implementation, operational readiness, payer communications, provider enrollment coordination, and ongoing contract performance monitoring.
Executes and manages complex legal, financial, operational, and reimbursement contract negotiations with national, regional, government, and commercial payers.
Develops and executes contracting strategies for all components of the health system, including hospital, physician, transplant, ancillary, specialty network, and other integrated healthcare services across fee-for-service and value-based reimbursement arrangements.
Monitors and responds to insurance industry trends, healthcare reform initiatives, payer strategies, legislative and regulatory changes, payor policy modifications and competitive market dynamics to maintain and strengthen the organization's strategic position.
Escalates, monitors, and manages payer operational issues identified through revenue cycle operations, Central Business Office activities, Joint Operations Committee meetings, and other governance structures.
Collaborates with payer and organizational leadership to drive issue resolution and mitigate operational, financial, or legal risk.
Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations.
Creates an effective control environment, conducts risk assessment, implements, and monitors controls.