Executive Director of Managed Care Contracting - Health Services Contracting (HYBRID)
About The Position
UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America's Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. To learn more about UCI Health, visit www.ucihealth.org. Your Role on the Team Position Summary: Incumbent defines and implements strategy and contract performance expectations for the enterprise. The incumbent is responsible for managing and directing a staff of contracting professionals that negotiate and draft contracts with aggregate impact more than $1.5 billion. The incumbent is responsible to suggest and implement innovative reimbursement strategies, including value-based care, bundled payment programs and initiate participation in innovative networks/programs to optimize financial performance, while helping to prioritize the team efforts to maximize our growth opportunities. The incumbent provides effective drafting, review, negotiation, execution, implementation, and evaluation of all contracts including, health plan, clinical services, ancillary, and other contracts that support the Enterprise. The incumbent establishes, implements and maintains contract relationships with referral medical groups, referral hospitals, health plans and other third-parties to enable patient referrals. The incumbent will report to the Executive Director, Enterprise Managed Care Contracting.
Requirements
- Working knowledge of complex provider relations, credentialing activities.
- Thorough understanding current reimbursement methodologies and ability to distinguish the most effective method for each situation.
- Must demonstrate customer service skills appropriate to the job
- Must be self-motivated and goal driven.
- Minimum of 3 years' management experience in a highly complex, diverse health care organization
- Minimum 8 years' provider contracting experience in a managed care environment, including negotiation, preparation, review, administration, maintenance, and monitoring of contracts.
- In-depth knowledge of Medicare and MediCal policies, practices, and reimbursement strategies
- In-depth knowledge and experience in managed care, value-based contracting, Medicare Advantage, capitation, narrow networks, and other innovative payment models.
- Extensive experience dealing with payors or providers.
- Evidence of sound critical thinking skills and the ability to think creatively and strategically to problem solve
- Demonstrated ability to interact effectively, build trust and establish effective working relationships across the Health System and with a wide variety of audiences
- Bachelor's degree in business, Finance, Healthcare or related discipline or equivalent experience
- Ability to maintain a work pace appropriate to the workload
- Ability to implement business plans and contracting activities to achieve objectives.
- Ability to critically evaluate options, tradeoffs within contracting opportunities.
Nice To Haves
- Master's Degree
Responsibilities
- Incumbent defines and implements strategy and contract performance expectations for the enterprise.
- Responsible for managing and directing a staff of contracting professionals that negotiate and draft contracts with aggregate impact more than $1.5 billion.
- Responsible to suggest and implement innovative reimbursement strategies, including value-based care, bundled payment programs and initiate participation in innovative networks/programs to optimize financial performance, while helping to prioritize the team efforts to maximize our growth opportunities.
- Provides effective drafting, review, negotiation, execution, implementation, and evaluation of all contracts including, health plan, clinical services, ancillary, and other contracts that support the Enterprise.
- Establishes, implements and maintains contract relationships with referral medical groups, referral hospitals, health plans and other third-parties to enable patient referrals.
Benefits
- We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
Industry
Educational Services
Number of Employees
5,001-10,000 employees
