Director of Managed Care

Jupiter Medical Center

12d

About The Position

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast. Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS). Director of Managed Care strategically leads the team that is responsible for negotiating payer agreements on behalf of Jupiter Medical Center. The Director participates in the development, negotiation, implementation, monitoring and management of all third-party payor contracts. Director will develop and maintain a network of relationships with third party payors, establish and maintain effective relationships with executives, operational leaders, as well as colleagues and peers within revenue cycle and finance. Develop and implement the strategy, objectives, techniques, and tactics to achieve the strategic goals of the Organization. Collaborate with cross-functional teams to negotiate contracts and analyze provider networks, ensuring optimal value and quality. Strategically assess various contract relationships to determine appropriate changes based upon local market dynamics. Evaluate managed care contracts, performance, and reimbursement rates to identify areas for improvement. Stay abreast of changes in healthcare regulations and industry trends, and recommend adjustments to managed care strategies that anticipate changes that are forthcoming. Oversee the development and maintenance of provider relationships, fostering open communication and collaboration. Lead and mentor a team of managed care professionals, providing guidance, coaching and support to develop a team rooted in excellence and forward thinking. Analyze data and financial metrics to identify opportunities for cost savings and process improvements. Interface with executive leadership to provide regular updates, reports, and recommendations related to managed care strategies. Collect, organize, and timely submit all credentialing requests. Manage contracting for hospitals, physician, and ancillary providers. Assist in auditing of payments collaboratively with other departments to address and resolve operational issues as it relates to negotiated contract language. Prepare, analyze, review, and project financial impact of provider contracts and alternate contract terms. Develop the strategy to incorporate the delivery and reimbursement for new technologies into existing and future contracts. Understand and enforce all hospital and personnel policies and procedures. Perform other duties as assigned.

Requirements

Bachelor’s degree in healthcare administration, business administration or finance, or equivalent experience required.
Minimum of seven years’ experience in managed care and healthcare administration, working with third party payers and managed care organizations is required.
Keen negotiating skills and contract management skills.
Experience with data analysis and financial modeling.
Excellent analytical skills and problem-solving abilities, including the ability to interpret complex data and drive data-driven decisions.
Knowledge of hospital and managed care finance, as well as healthcare regulations and compliance standards, including HIPAA and CMS guidelines.
Excellent communication and interpersonal skills, with the ability to effectively collaborate with various stakeholders both internally and externally.
Strong written and verbal communication skills and experience with formal presentations.
Team player with proven ability to develop strong working relationships with stakeholders across all levels of the organization.
Demonstrated leadership ability to build teams, develop talent, and foster a culture of collaboration.
Excellent project management skills and demonstrated ability to prioritize and oversee multiple initiatives.
Ability to maintain confidential and company proprietary information.
Requires sitting for long periods of time, also stooping, bending, standing, and stretching.
Must have manual dexterity for typing and computer data entry.
Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated.
Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation.
TB/PPD Surveillance Program
Maintenance of required professional licensing and/or certification(s).

Nice To Haves

Master’s degree in healthcare administration, business administration, or related field preferred

Responsibilities

Strategically leads the team that is responsible for negotiating payer agreements on behalf of Jupiter Medical Center.
Participates in the development, negotiation, implementation, monitoring and management of all third-party payor contracts.
Develop and maintain a network of relationships with third party payors, establish and maintain effective relationships with executives, operational leaders, as well as colleagues and peers within revenue cycle and finance.
Develop and implement the strategy, objectives, techniques, and tactics to achieve the strategic goals of the Organization.
Collaborate with cross-functional teams to negotiate contracts and analyze provider networks, ensuring optimal value and quality.
Strategically assess various contract relationships to determine appropriate changes based upon local market dynamics.
Evaluate managed care contracts, performance, and reimbursement rates to identify areas for improvement.
Stay abreast of changes in healthcare regulations and industry trends, and recommend adjustments to managed care strategies that anticipate changes that are forthcoming.
Oversee the development and maintenance of provider relationships, fostering open communication and collaboration.
Lead and mentor a team of managed care professionals, providing guidance, coaching and support to develop a team rooted in excellence and forward thinking.
Analyze data and financial metrics to identify opportunities for cost savings and process improvements.
Interface with executive leadership to provide regular updates, reports, and recommendations related to managed care strategies.
Collect, organize, and timely submit all credentialing requests.
Manage contracting for hospitals, physician, and ancillary providers.
Assist in auditing of payments collaboratively with other departments to address and resolve operational issues as it relates to negotiated contract language.
Prepare, analyze, review, and project financial impact of provider contracts and alternate contract terms.
Develop the strategy to incorporate the delivery and reimbursement for new technologies into existing and future contracts.
Understand and enforce all hospital and personnel policies and procedures.
Perform other duties as assigned.