Director of Managed Care Contracting
Director of Managed Care Contracting
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
The Director of Managed Care Contracting is responsible for leading the strategic planning financial analysis negotiation and execution of new and renewed managed care agreements across an assigned hospital portfolio. This role serves as a key corporate liaison partnering closely with Operations Business Development and cross-functional corporate teams to ensure alignment and support throughout the contracting lifecycle.
The primary focus of this position is to drive net revenue growth through the development of favorable contracts that exceed the cost of care delivery. Additionally the Director will work to maximize referral volume from each executed agreement and identify opportunities to expand out-of-network volume where appropriate.
This role also plays a critical leadership function in the integration of newly acquired hospitals and in managing contracting implications related to hospital consolidations and closures.
Responsibilities
- Analyze negotiate and implement new and renegotiated contracts for assigned hospital portfolio. Develop payor strategies to ensure optimal contracting and operational performance for hospitals.
- Responsible for rate and payment methodologies contract language as well as following all internal controls for contract review and administration approval and signature.
- Manage implementation of new contracts/renegotiations/physician agreements.
- Manage and act as corporate liaison for assigned regional and national contracts.
- Oversee credentialing/re-credentialing and billing/reimbursement development.
- Ensure COLAs are administered in accordance to contract terms.
- Complete and execute Single Case Agreements.
- Liaison between DBDs CEOs CBO and Payor Provider Relations staff to assure that the requirements of a contract can be implemented and maintained.
- Coordinate contracting efforts in conjunction with business development initiatives.
- Develop and implement roll-out of new contracts including post analysis reports.
- Assist DBDs and CEOs in detail review and the analysis of actual-to-expected payor rate per patient day reimbursement for current contracts.
- Assist with Billing office reimbursement projects and issues.
- Lead role for key payor meetings and issues/resolution tracking.
- Serve as Hospital payor relations admissions and case management support.
- Promote use of Contract Information System and other tools.
- Develop and maintain positive payor relations identify and address issues.
- Respond to inquiries and issues for new and renegotiated contracts.
- Regularly review insurance verifications at request of hospital staff.
- Coordinate information and analysis requests from corporate case management.
- Ensure Critical Illness Recovery Hospitals and Inpatient Rehabilitation Hospitals maximize utilization of contracts.
- Participate in new employee orientation of Director for Business Development and others.
- Obtain payor contacts for new contracts to establish initial and ongoing meetings.
- Chair quarterly trend report calls and disseminate market findings/opportunity and track post meeting action items and status.
- Coordinate meetings with hospitals to resolve payor and/or volume issues market consolidations and closures as requested.
- Business Development and Integration.
- Evaluate JV and Acquisition opportunities to help Operations and Finance conduct due diligence.
- Oversee contract and credentialing implementation for new hospital openings/closures/mergers JVs and acquisitions.
- Develop and follow an integration playbook.
- Set goals and objectives each fiscal year and provide guidance in accordance with department objectives policies and procedures.
Qualifications
- Bachelors degree or higher preferred or equivalent work experience.
- 3-5 years demonstrated experience in a managed care setting hospital setting preferably working in contracting or provider relations arenas
Required Experience:
Director
Employment Type
Unclear
