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Director of Managed Care - Commercial Insurance

Company: Wheeler Staffing Partners
Location: Garland
Posted on: March 27, 2020

Job Description:

The Director of Managed Care is responsible for developing and implementing the payor strategy for payor reimbursement for private (e.g. health plans, employer-sponsored), self-funded employers, and governmental payors that include fee for service contracts and value-based payment models resulting in optimal reimbursement for the contracted providers.The Director is responsible for developing and managing the payor strategy and relations, including network development, biannual payor contract reviews and keeping leadership informed of market changes that may impact the organization. This includes, but is not limited to, developing and implementing new payor reimbursement models such as total cost of care (TCOC), pay for performance, bundling, etc., based on accountability, value and working with private and government payors to establish mutually beneficial partnerships.The Director is also responsible for researching, developing and recommending new sources of revenue to support the organization's overall system contracting, payor/employer relations, contract compliance and contract administration. The Director demonstrates a high level of customer service skills to establish and enhance positive relationships with other departments and co-workers, providers and other stakeholders.Essential Duties and ResponsibilitiesDevelop and lead the execution of national and regional contracting initiatives, including negotiations and provider relations functions including private (e.g. health plans, employer-sponsored), self-funded employers, and governmental (e.g. Medicare, Medicaid) payorsInterface with senior leadership on the development and execution of complex payor/network contracting strategyNegotiate physician, ancillary and other contracts on behalf of the company and its affiliates, including fee for service, value-based and population health payment model agreementsUse, create, and synthesize data to develop and drive payor contracting and departmental strategiesProactively track and report all contracting effortsConduct regular status updates with core team, and provide management with a clear sense of progress and understanding of any marketplace changes (major insurance, network and reimbursement issues, changes in legislation or in guidelines at the federal levels) during the performance yearCollaborate with Account Managers to validate contract performance and compliance.Develop market-based purchasing strategies to drive market changes around purchasing healthcare services, to include cost and qualityWork closely with regional/division leadership to ensure that contracting efforts align with regional/division goals where appropriateAct as liaison between payor contracting, care management (providers), and revenue cycleEffectively manage contract deadlines and renewalsCommunicate with relevant stakeholders to ensure contract commitments are operationalizedLead the development of tools to model contracts and monitor payor performanceDevelop and oversee a direct to employer and broker strategyIdentify and implement best practices in payor contracting and contract managementKnowledge, Skills and ExperienceBachelors Degree in Finance, Accounting, HCA or a related field required, Masters preferred7+ years of Payer or Provider contracting and reimbursement experience requiredPrior health care provider or health plan contracting, contract operations, service operations, or provider relations experienceHospital, ASC and Physician reimbursement experience is essentialExcellent negotiation skills with a verifiable track record of resultsStrong Attention to Detail, Organizational and Project Management skills requiredComprehensive knowledge of Microsoft Office applications (Excel, Access, PowerPoint)Proficiency in analyzing, understanding and communicating financial trendsOutstanding communication, presentation, negotiation and relationship-building skills; able to engage with all levels of an organizationAbility to manage multiple priorities in a fast-paced environment and exercise independent judgement on matters of significance.Travel required (25%-50%)$130k-150k plus bonus

Keywords: Wheeler Staffing Partners, Garland , Director of Managed Care - Commercial Insurance, Executive , Garland, Texas

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