Regional Director of Managed Care Contracting
Melville, NY, USA | North American Partners in Anesthesia
Industry:Healthcare - Hospitals
Job Description:57 people have viewed this job
In this role, the Regional Director of Managed Care Contracting will report to the Vice President of Managed Care Contracting and Payor Relations, and will be a key member of the senior management department team.This positon is accountable for achieving financial and business objectives in multi-state negotiations and the management of a team of Payor Relations and Contracting Managers responsible for the contract negotiations and operational activities of assigned markets.The Regional Director is accountable for implementing and supporting creative payor strategies to achieve the optimal financial and operational performance goals of the organization.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Oversee the strategic development of Managed Care, IPA, and Payor Contracts on a national, regional, and local level for multiple lines of business including commercial and governmental products.
Provide support and expertise to contract managers in developing and analyzing large and complex data sets for the creation of financial rate models, make proposal recommendations in negotiating/renegotiating and implementing rates and terms for health plan contracts, ensuring key operational and financial budget objectives are met.
Lead, develop and identify negotiation strategies for value based contract negotiations with payors, while working collaboratively with internal key stake holders to execute and manage such arrangements.
Review and evaluate contract language and reimbursement terms in existing and potential managed care agreements, and to make recommendations and execute any modifications required for the benefit of the organization.
Cultivate relationships and maintain strong communications with health plans and payor contacts.
Prepare financial reports to review and assess utilization trends and overall financial performance of contracts, and identify improvement opportunities with rates/contract language, with the development of action plans to carry out improvements.
Establish performance expectations and provide staff coaching to achieve positive results. Recognize effective performance, and address performance needing improvement in an honest and timely manner.
Secure support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge.
Monitor, interpret, evaluate and report on changes in payor performance, market trends, health care delivery systems, and legislative initiatives that impact managed care efforts (e.g., CMS, State DFS, Health Care Reform, etc.) and provide recommendations to adapt to a changing health care industry.
EDUCATION / EXPERIENCE:
Minimum BA/BS in Business Administration, Healthcare Administration degree; advanced degree preferred.
Minimum 8 + years’ demonstrated experience in leadership negotiating and managing contracts within the health care industry working on either the health plan or provider side.
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Demonstrated strong knowledge of managed care regulations, state legislation, and laws related to health care and health care operations, as well as value based and analytical models.
Ability to travel to the corporate office and within assigned region.
Strong negotiation and interpersonal skills; strong written, verbal and analytical skills; motivated and a proactive strategist with the ability to adhere to deadlines; work to “get the job done”. Must be a “self-starter” with the ability to multi-task.
Superior strategic and critical thinking skills with the ability to effectively communicate clear and concise direction to all levels.
Professional business sense and presentation skills; strong knowledge of reimbursement methodology types (i.e. case rates; unit rates, fee for service etc.).
Proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs
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