Executive Director Managed Care Operations
Executive Director Managed Care Operations
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1 Vacancy
Job Description
Current Employees:
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The Department of Business Development and Managed Care is currently seeking an Executive Director Managed Care Operations to work at our offices in Medley Florida. The Executive Director Managed Care Operations develops implements and optimizes the financial performance and operationalization of all thirdparty managed care contracts and single case negotiations across all University of Miami Health System hospitals ambulatory service centers employed physician practices and departments. The incumbent also assumes responsibility for directing all timely and accurate provider loading and configuration of UM credentialed employed physicians within all contracted thirdparty managed care payers.
The incumbent is responsible for and oversees Business Operations Provider Data Management and Contract Lifecycle Management including Health Plan contract Audits and Revenue Cycle support. Responsibilities also include the creation implementation and maintenance of all Managed Care and Business Development departmental policies and procedures to meet the standards of the health system and other outside accrediting bodies including JCAHO AHCA CMS etc. Reporting to the UHealth Associate Vice President of Managed Care the incumbent leads and manages the Managed Care and Business Operations teams and all downstream functions.
CORE JOB FUNCTIONS
Leads all Managed Care/Business development areas and functions including Managed Care Strategic Planning Contracting and Negotiations Management Operations and Contract Implementation Provider Data Management & Credentialing Downstream Payer Relations Contract Lifecycle Management and Auditing for all UHealth/health plan partnerships for the University of Miami Health System.
Maintains current knowledge of community developments as it pertains to competitive issues in managed care.
Leads and manages care staff including network contracting contract implementation/operations nonparticipation agreements provider roster data management reporting and special projects.
Collaborates with internal peers and senior leaders advising on medical economics and contract modeling revenue cycle functions audits and collections activities and counsels medical department leadership on managed care protocols and strategy.
Leads and participates in all managed care contracting negotiations for the health system.
Oversees all singlecase negotiations and operations process for the health system.
Partners with legal counsel to review proposed and existing contract language.
Leads training on new procedures supplies and pharmaceuticals being used for inclusion in the managed care contracting process.
Oversees implementation stages of the hospital and physician managed care contracting process.
Directs auditing process of hospital and physician managed care contracts to measure and maintain compliance.
Establishes and maintains relationship with local and national health plan leadership.
Hosts meeting with Health Plan and University leadership.
Ensures internal control oversight and compliance with laws and regulations safeguarding of assets compliance with University policies and procedures reliability of internal and external reporting and efficiency and effectiveness of operations. Creates an effective control environment conducts risk assessment implements and monitors controls.
Identifies evaluates and responds to trends and future federal and state policies as they relate to changes which might impact the contracting function and UHealth rates
Ensures internal control oversight and compliance with laws and regulations safeguarding of assets compliance with University policies and procedures reliability of internal and external reporting and efficiency and effectiveness of operations. Creates an effective control environment conducts risk assessment implements and monitors controls.
This list of duties and responsibilities is not intended to be allinclusive and may be expanded to include other duties or responsibilities as necessary.
CORE QUALIFICATIONS
Education:
Bachelors degree in relevant field
Experience:
Minimum 10 years of relevant experience
Any relevant education certifications and/or work experience may be considered.
Knowledge Skills and Attitudes:
Knowledge of business and management principles.
Ability to direct manage implement and evaluate department operations.
Ability to establish department goals and objectives that support the strategic plan.
Ability to effectively plan delegate and/or supervise the work of others.
Ability to lead motivate develop and train others.
Ability to maintain effective interpersonal relationships.
Ability to exercise sound judgment in making critical decisions
The University of Miami offers competitive salaries and a comprehensive benefits package including medical dental tuition remission and more.
UHealthUniversity of Miami Health System South Floridas only universitybased health system provides leadingedge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center we are proud to serve South Florida Latin America and the Caribbean. Our physicians represent more than 100 specialties and subspecialties and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching research and patient care. Were the challenge youve been looking for.
The University of Miami is an Equal Opportunity Employer Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.
Job Status:
Full timeEmployee Type:
StaffPay Grade:
H21Required Experience:
Director
Employment Type
Full-Time
