Managed Care Regional Director
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 Managed Care Regional Director 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/yr (DOE) Schedule: (Remote) Monday - Friday, 8:30am - 5:00pm PST Location: Virtual CA 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
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- 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
- 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 of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
- 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 payers 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 medical and pharmacy plans 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 relationships 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
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What This Job Offers
Job Type
Full-time
Career Level
Director
