Director of Managed Care

CSI Companies

31d•$150,000 - $180,000•Remote

About The Position

At CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission. Summary The Director of Managed Care will be responsible for evaluating, negotiating, credentialing, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. Salary Range: $150,000 - $180,000 (DOE) Schedule: (Remote) Monday - Friday, 8:30am - 5:00pm Location: Virtual, United States Travel: This position is expected to travel up to 25 - 30% for various conferences, sales meetings, etc. with the longest being 4 weekdays at a time

Requirements

Bachelor’s Degree preferred or equivalent experience
At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience

Nice To Haves

Preferred experience in managing, analyzing, and reporting denials and appeals.

Responsibilities

Leads the implementation process of managed care contracts and develops and maintain systems to disseminate contract information
Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers
Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
Responsible for coordination and communication between managed care and other interested party departments and leadership
Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
Oversight of payer credentialing
Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
Communicates with respective payers related to trends and compliance with contract parameters
Consistently represents the company in a professional manner
Maintain effective working relationship and cooperate with all personnel in the Company
Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies
Perform other duties and responsibilities as assigned
Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contracts
Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possible
Must possess the ability to multi-task and frequently change direction