Director Managed Care

This is a hybrid position where the Director Managed Care will work from home but will,

be expected to be on-site when requested.

Position Summary :

The Director of Managed Care (D-MC) is responsible for identifying and negotiating local / regional Managed Care and Governmental agreements with applicable health plans identified via the Company and Regional Payor Strategy. The D-MC will work with our licensing, operations, and credentialing team to identify and assure the credentialing of our Providers and facilities is completed and updated as needed.

Qualifications : Education :

• Bachelor's degree in Business Administration, Accounting, Health Care Management, Information Systems, or a quantitative field of study (i.e., mathematics, economics, sciences, finance, etc.).
• Master’s degree in Business Administration preferred.

Experience

Special Skills :

Excellent communication and critical thinking skills.

Ability to work effectively and collaboratively with leadership colleagues, physicians, department heads, and members of the executive leadership.

Demonstrated proficiency with Microsoft Outlook, Word, Excel, Explorer and PowerPoint required with samples presented if requested during interview.

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.

Demonstrates the ability to interact with others in a way that gives them confidence in intentions and those of the organization.

Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying own behavior to accommodate tasks, situations and individuals involved.

Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral / written communication skills.

Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences.

Extensive knowledge of regulatory and accreditation agency requirements that impact department; stays abreast of industry changes.

The ability to work effectively in a fast-paced environment demonstrates flexibility and adaptability in the workplace.

Capable of leading teams / facilitating groups, building consensus and garnering highest confidence in professionalism and work product by leadership.

Ability to work under pressure and balance many competing priorities; highly responsive and solution / action oriented.

Maintains a positive and supportive attitude and demeanor always as Professional handling of exposure to confidential / sensitive information.

Demonstrated history of innovation and results focused outcomes.

Duties & Responsibilities :

Works closely with RCM team, finance, and others to secure appropriate payment under our revenue cycle operational activities and leading settlement efforts on old, unpaid claims that need to be closed out.

Supports the payor’s needs for any identified acquisition opportunities within the territory with both due diligence and integration of key payors and credentialing. These drive change in a large, highly matrixed organization, leveraging data, analytics, and best-in-class technology to deliver revenue uplift.

Responsible for building effective internal partnerships and promoting collaborative relationships with regional leadership and enterprise shared services, including finance, reimbursement, payer contracting, information technology, legal, and compliance.

Maintains current knowledge of industry trends and regulatory requirements and has considerable expertise in payer contracts.

Works collaboratively with RCM system leadership to develop and execute system payer and network development strategy.

Maximizes operational standards related to third party payment and facilitates enhanced access to the organization for members of the community.

Integrates and aligns payer strategy with CMC’s strategic objectives, including population health strategies, value-based contracting strategies, contract management, operations processes, and government reimbursement trends. Includes integration (relative to payer strategy) across key CMC functional areas of Revenue Cycle Management, Finance, Reimbursement, Legal, Business Development, and Health Plan Operations.

Provide financial and contract-based decision support and program analytical services to support business development and operational decision making and payor contracting.

Responsible for Conway Medical Center (CMC) payor contract builds, modeling, integration, and coordination from request to approval and into production.

Serves as a revenue cycle expert for CMC migration, integration, and modeling of payor contracts into Cerner contract management platform.

Advises and directs management staff on higher level decisions or problem resolutions to support payment variance contract assessments, quality assurance, build investigation, contract integration, and operational contract interpretation.

Management of staff oversight for evaluating system build and reconciliation process to ensure accurate contractual are taken at the time of billing per the analysis, review, and maintenance of CMC’s Contract Management applications as outlined in the payor contract language.

Manages various department reports, both ad-hoc and routine, to assist in the identification of payment variance opportunities and other payment irregularities.

Works with the Denial department with the build and modeling of contract proposals, including what-if scenarios, to demonstrate potential reimbursement, opportunities and / or shortfalls.

Ensures CMC patient accounts have an accurate expected reimbursement per the managed care contract language and system build.

Works directly with managers in managing vendor partners and acts as vendor liaison to reduce revenue leakage from Conway.

Completes other duties as assigned by department leadership

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