Managed Care Operations, Executive Director

Northeast Georgia Health System•Gainesville, GA

About The Position

The Director of Managed Care conducts and coordinates the functions involved in Managed Care operations and contracting activities at the System level. Monitors and updates the administrative staff on political, legal and regulatory trends with respect to managed care and vertical integration. Works with Medical Economics, Finance and Revenue Cycle to produce reports for the Executive Director concerning managed care contract modeling and contract performance. This position is responsible for managed care financial analysis and analyzing contract proposals. This position is responsible for the medical economics staff and operation. This position will work with the various Revenue Cycle components/departments to ensure negotiation of the most appropriate contract terms/structures, etc. This position will work as a liaison between with managed care payers and system to facilitate resolution of contractual and operational issues in order to enhance managed care contract performance.

Requirements

Bachelors Degree.
Seven (7) years of managed care contracting and/or managed care finance experience.
Possess extensive knowledge of the Managed Care environment in Georgia or similar market
Possess successful relationship building skills
Self motivated with strong organizational and planning skills
Good written communication skills including email
Excellent analytical skills through use of various spreadsheet software (i.e. Excel), querying software and/or contract management programs

Responsibilities

Responsible for research, analysis and negotiation of contractual agreements.
Attend meetings with representatives of Managed Care Organizations, gathering information on their market presence and future development.
Coordinate the review of managed care contract language to achieve optimal reimbursement for NGHS and to promote internal efficiencies among internal departments that are affected by said contracts.
Perform service specific reviews of volume and pricing in an effort to maximize contract performance.
Coordinate, prepare for and attend regular negotiation meetings with contracting parties.
Coordinate the administration/management of contracts through NGHS system, ensuring the dissemination of appropriate contract information to necessary internal/external users.
Responsible for producing accurate final original documents.
Development of the Medicare Advantage strategic goals and objectives, including the community focus and contracting strategic plan.
Support VP of Managed Care in new contracting initiatives such as pay for performance.
Establish relationships and serve as operational contact point with all contracting parties.
Maintain lines of communication with payer contracting staff throughout contract item.
Coordinate meetings with payers where the need is related to joint operations.
Work with VP and Senior Management to lead the departmental efforts for effective employer engagement in an effort to prepare NGHS for a future with potential employer direct contracting.
Oversee the additional of new facilities, new physicians and new services to managed care contracts.
Serve as a liaison between various NGHS departments and Managed Care Operations.
Oversee response to calls and emails from NGHS departments.
Improve overall Managed Care integration into the NGHS organization through communication.
Coordinate communication and education of physicians to ensure most accurate administration of contracts and efficient NGHS operations.
Coordinate communication and education of staff to ensure most accurate administration of contracts and efficient NGHS operations.
Oversee the development and monitoring of managed care contracts.
Develop and evaluate reports regarding the managed care contract performance and payment variances.
Oversee managed care payment variance review function.
Manage and maintain annual schedule of terminations, renewals, escalators, etc.
Analyze payment variance reports/trends.
Coordinate activities related to contract rate development, modeling prediction, and other analyses as required to support NGHS Finance and Revenue Cycle.
Manage and coordinate Medical Economics department.
Act as the point of contact for Finance and Revenue Cycle concerning procedure pricing (CDM), contract rates and managed care contract performance.
Coordinate with report building for various departmental needs.
Coordinate with payer research relative to new technologies contemplated by NGHS.
Coordinate information gathering and feedback with industry experts on managed care market environment and NGHS relative market position.