Director, Managed Care

Sutter Health•Sacramento, CA

About The Position

Oversees and directs pay negotiations and projects which support the payer contracting strategy, compliance and process, litigation management as assigned, as well as contract compliance enforcement, including ongoing contract relationships for all Sutter Health affiliates and/or associates. Develops and executes various strategic initiatives related to managed care activity, education and supports operating unit and system leadership with acquisitions and performance goals related to managed care contracting matters and direct to employer initiatives. Coordinates and leads teams in negotiations with various payers for a variety of types of provider reimbursement, including value and performance based compensation models, ACOs and quality programs on behalf Sutter Health affiliates for commercial and government programs. Oversees and supervises administrative contracting processes and provider relations staff, ensuring accountability for performance of work and further development of staff career goals.

Requirements

Bachelor's: Healthcare Administration, Business Administration or other related healthcare field
12 years recent relevant experience.
Knowledge of market imperatives and trends for healthcare providers.
Ability to perform managed care contract analysis, draft language, document review, and work with operations to support contract compliance.
Advanced knowledge of the operational implications of managed care contracts relative to both medical groups, ancillary providers and hospitals.
In-depth understanding of all regulatory requirements for contracting and compliance as it relates to Knox-Keene, Department of Managed Health Care (DMHC), Department of Insurance (DOI), Centers for Medicare and Medicaid Services (CMS), Health Insurance Portability and Accountability Act (HIPAA) or Employee Retirement Income Security Act (ERISA).
Ability to influence and facilitate senior executive teams as needed to ensure the effective management of complex, multi-faceted project management.
Skills with Power Point and Word processing software.
Demonstrated ability to negotiate managed care contracts and develop and draft contract language.
Ability to build consensus through effective communication skills both written and oral.
Presentation and organizational skills.
Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/or agendas.
Ability to influence and facilitate senior executive teams as needed to ensure the effective management of a complex, multi-faceted project.
Ability to enlist cooperation and build teams committed to carrying out initiatives in environments that may be resistant to change and not under the incumbents direct authority.
Ability to maintain a high level of energy and creativity as well as the ability to work independently, prioritize multiple objectives and tasks in a rapidly changing environment and deliver quality outcomes.
Ability to develop and create reports or other presentations to operational or executive teams.

Responsibilities

Oversees and directs pay negotiations and projects which support the payer contracting strategy, compliance and process, litigation management as assigned, as well as contract compliance enforcement, including ongoing contract relationships for all Sutter Health affiliates and/or associates.
Develops and executes various strategic initiatives related to managed care activity, education and supports operating unit and system leadership with acquisitions and performance goals related to managed care contracting matters and direct to employer initiatives.
Coordinates and leads teams in negotiations with various payers for a variety of types of provider reimbursement, including value and performance based compensation models, ACOs and quality programs on behalf Sutter Health affiliates for commercial and government programs.
Oversees and supervises administrative contracting processes and provider relations staff, ensuring accountability for performance of work and further development of staff career goals.