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Senior Director Managed Care Contracting

Louisville, Kentucky
Facility ScionHealth Corporate Support Center
Req ID 511043 Post Date 06/05/2024
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Description

ScionHealth is recruiting for a Senior Director, Managed Care, to join our team!Qualified remote candidates will be considered for this role.

Job Summary

The Senior Director, Managed Care leads negotiation of managed care Payor agreements between ScionHealth and various payer organizations.This includes but is not limited to the negotiation of Commercial, Medicare, and Medicaid products for both Hospital and Physician practices.The position works in conjunction with Community Hospitals, Physician Services and Division Leadership as well as Revenue Cycle to support ScionHealth’s overall managed care and operational strategies.

These duties are performed while operating within the established budgetary and business guidelines in coordination with the VP of Managed Care and the leaders of the Community Hospital Division.

Essential Functions

  • Participates in strategic planning, development, and enhancement of revenue of managed care contracts.
  • Plans and develops financial plans, including budgets, revenue projections for Managed Care contracts.
  • Directs the coordination and integration of managed care services with other departments and the primary functions of their market facilities.
  • Provides for orientation, in-service training, continuing education, annual performance, and competency reviews of managed care personnel to ensure staff is competent to provide services.
  • Gives direction to the Physician Managed Care Contracting.
  • Responsible for all Managed Care contract negotiation and execution, team building, and company managed care marketing initiatives.
  • Oversees and participates in the development, negotiation, implementation, monitoring, and management of all assigned managed care agreements.
  • Evaluates and recommends financial parameters and reimbursement methodologies.
  • Implements new managed care programs in conjunction with faculty, staff, and hospital/practice administration.Keeps staff apprised of developments in the managed care marketplace.
  • Directs and participates in financial analysis of revenue projections based on contractual rates with payers, adverse trends, terms and appropriate recommendations or conclusions.
  • Analyze and monitor financial aspects of existing managed care contracts.Utilize analysis for feedback on contract renewals, renegotiations, or termination.Make recommendations regarding participation or non-participation with new or existing agreements.
  • Facilitates promotion of departmental programs to provider networks.
  • Develop and audit payer fee schedules based on negotiated reimbursement rates by contract and/or product line.
  • Maintain and distribute participation information by payer by network product for all signed contracts, contracts under-negotiation, or plans not being negotiated.
  • Responsible for reviewing managed care legal contract language and negotiating language to meet agreed to parameters with legal counsel to lessen risk and improve operational efficiencies.
  • Strategic planning accountability for other reimbursement & profitability endeavors with subcontract agreements, government programs, pay for performance initiatives.
  • Assembles information and prepares materials for presentation to committees, administrators, and managed care networks.
  • Perform special projects as requested by the Vice President, Managed Care.
  • Liaison with physician practices, hospitals, other affiliated organizations, and managed care organizations regarding issues pertaining to managed care.
  • Initiate contact with Managed Care Plans to begin negotiation/re-negotiation process.
  • Work with the Revenue Cycle as needed to establish negotiating position.
  • Coordinate with Revenue Cycle Groups to ensure contract compliance and troubleshoot reimbursement issues.
  • Coordinate Physician contracting with hospital and ancillary agreements.

Knowledge/Skills/Abilities

  • Self-motivated and results oriented.
  • Ability to apply knowledge of medical terminology and payor reimbursement methodologies including managed care requirements and strategies.
  • Strong organizational skills.
  • Excellent oral and written communication and interpersonal skills.
  • Ability to communicate in English effectively through verbal and written means.
  • Ability to work under stress with conflicting priorities and deadlines.
  • Ability to think critically.
  • Ability to review and understand contract language.
  • Ability to make presentations.
  • Ability to conduct negotiations.
  • Computer skills including Microsoft Office software.
  • Ability to travel approximately 20% of the time.

Qualifications

Education

  • Bachelor’s degree in business or related field or relevant work experience required; Master’s degree preferred.

Experience

  • Minimum ten years’ healthcare experience, including at least eight years’ experience in healthcare managed care.
  • A minimum of six years' experience in negotiating hospitals and physicians managed care agreements required.

Technical Skills

  • Clinical and medical technology knowledge.
  • Computer skills – Proficient in Word/Excel/PowerPoint.

Depending on a candidate's qualifications, this role may be filled at a different level. 

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