Regional Director of Managed Care

Infucare Rx Inc on behalf of itself and its subsidiaries

About The Position

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team-oriented, and quality work environment for our employees that cultivates achievement and success. Position Overview: The Regional Director Managed Care, reporting to the VP, Managed Care is responsible for managed care relationships, credentialing and contracting within a defined geography and/or assigned Payor portfolio to advance enterprise initiatives. This position will support the Contracting Team by facilitating Payor credentialing, strategic reporting, and assigned contracting functions while providing network clarity/support to internal/external stakeholders.

Requirements

3+ years relevant network experience including significant managed care contracting duties with demonstrated ability in the areas of financial analysis, payment methodologies, contract language and negotiations.
Bachelor’s degree required.
Equivalent experience considered.
Ability to understand, read, write, and speak effectively to communicate concepts.
Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to successfully write business correspondence.
Ability to recognize and define problems, collect data, establish facts, draw valid conclusions, and correct errors. Ability to understand and interpret basic financial data. Ability to interpret a variety of instructions in a variety of forms and deal with abstract and concrete variables.
Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.
Must be able to work well with and create/present material to others. Strong verbal and written communication skills required.
Must be detail oriented and organized. High integrity, including maintenance of confidential information.
Must be able to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency.
Based on business need, the ability to work a flexible schedule

Nice To Haves

Experience working in the acute or specialty infusion pharmacy industry.
Experience working for a national or regional payor or managed care entity.
Experience contracting with medical groups preferred.

Responsibilities

Perform credentialing, reporting, analysis/negotiation, or initial contracting as assigned.
Support negotiation of contractual and reimbursement terms with existing managed care entities.
Manage target/contracted accounts with focus on execution of pharmacy strategic plan through effective problem solving, critical and conceptual thinking, information seeking, communication, collaboration, project management, and business analysis.
Perform meeting preparation, credentialing maintenance and support functions as required/assigned to support effective contracting growth/maintenance within the Managed Care Department.
Maintenance of contracted relationships in assigned states, regions and/or specific managed care portfolio.
Ensure team alignment with all stakeholders in conjunction with organizational goals to foster success.
Collaborate with internal/external stakeholders to coordinate resources ensuring managed accounts meet business plan objectives plus strategic and sales goals.
Conduct periodic reviews of provider contracts as requested.
Develop tools and techniques that advance pricing/rate objectives.
Work with team to facilitate on quantify departmental and geographic portfolio performance.
Advance company effectiveness by providing internal/external team education/support on Payor landscape
Team player. Work effectively with all members of the Infusion Team to accomplish shared objectives.
Work with revenue team to maximize billing and collection of insurance claim receivables.
Understand and Work with the team on compliance with Federal, State plus local regulations, all applicable regulations, and to support continued Accreditation including JCAHO, ACHC, and URAC,
Maintain accurate and complete records.
Present a professional appearance and approach with employees; demonstrates honest and ethical behavior. Handle protected information with appropriate sensitivity/safeguards to ensure confidentiality plus the right to privacy in compliance with HIPAA regulatory requirements
Contribute to the effectiveness of the team by maximizing resources though effective utilization as well as supporting, promoting, and applying the best practice standards within scope of authority.
Facilitate constructive work environment of attendance, punctuality, on time delivery, mutual respect and support while honoring diversity, effective communication, and improving the workspace.
Adjust work distribution to meet service, delivery, and companywide goals
Take initiative to identify, develop and adapt new policies and practices to improve quality of work.
Actively support company mission, organizational/departmental policies, and procedures.
Performs other related duties as assigned by management.
Travel as needed.