Senior Director Managed Care Full Time

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

Leads and directs the development of new Commercial Payor opportunities within the Market by developing a wide continuum of products, services, and strategic relationships catering to the Healthcare Insurance Industry, developing policies, procedures, action plans and competitive pricing. These duties are performed while operating within the established budgetary and business guidelines in coordination with the VP of Managed Care and the Executive Directors and CEO's of the Market. Responsible for promoting, maintaining and assisting in the building of non-governmental referral sources to reach insurance admissions and census goals for the Group. Participates in the development, implementation and management of the Company's national marketing initiatives inclusive of positioning and contracting of Commercial Payors.  Provides operational and administrative direction to Managed Care Professionals in their designated market.

Essential Functions

Leadership

• Participates in planning and development of the Company's strategic, operational, service design and other organizational plans and policies to achieve the mission and vision of the Company.
• Plans and develops financial plans, including budgets, revenue projections, capital requirements and operational expenses and any other plans for allocation of fiscal or other resources according to the scope of services provided.
• Develops, designs and provides for a written scope of services, departmental policies and procedures that guide and support the provision and integration of services according to mission and vision of the Company and it's Operating units.
• Directs the coordination and integration of managed care services with other departments and the primary functions of their market facilities.
• Communicates the Company's mission, vision and goals to staff and motivates staff to implement supporting operational, programmatic and other plans.
• Recommends and determines the sufficient number of managed care professionals to provide services and defines qualifications, performance expectations and competence of each person.
• 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 Directors of Managed Care Contracting and Relationships.
• Participates in performance improvement activities to measure and assess the quality of services provided. Assures that clinical programs are responsive to the needs of payors, patients and families and referral sources. Assists in the development of specific programs that meet the expectations and requirements of the payor community.
• Responsible for all Managed Care contract negotiation and execution, team building, and company managed care marketing initiatives.

Job Specific

• Identifies and prioritizes target Managed Care Organizations by researching and evaluating service opportunities, market size, competitive environment, contract profitability, and other applicable factors in order to increase market share, maximize profitable revenues, and meet or exceed overall business goals and objectives.
• Maintains regular and open lines of communication with key and target customers by developing and managing close business relationships in order to monitor market conditions while remaining alert to new business opportunities and to ensure on-going account servicing in a manner that maximizes customer satisfaction while positioning Kindred favorably in the marketplace.
• Works closely with the senior staff in developing comprehensive sales and business plans as well as quarterly and annual revenue forecasts designed to meet and exceed the profit objectives of the company.
• Works with Managed Care Professionals to identify specific managed care outcomes, participate in joint marketing and program presentations and in the identification of issues that may be contributing to the blocking of future managed care admissions.    
• Identifies and attends critical National/Group conferences and meetings to educate MCO's to the programs, services and outcomes of Kindred Facilities.  Provides operating areas updates on activity, changes in industry, and new business opportunities. Develops, analyzes, and implements in conjunction with Managed Care Professionals, special reports/projects such as governing board reports, executive summary's, marketing action plans, strategic partnerships and alliances as may be required.
• Jointly with Managed Care Professionals, meets with key decision-makers in the community including contracted and non-contracted medical groups, workers compensation organizations, health plans and hospitals.
• Responsible for the development and management of financially viable managed care contracts.
• Maintains good rapport and cooperative working relationships with clients.
• Represent the organization in a positive professional manner in the community.

Company Specific

• Adheres to dress code, appearance is neat and clean and wears appropriate identification when appropriate. 
• Completes annual health, safety, and education requirements.  Maintains professional growth and development.
• Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Reports to work on time as scheduled; adheres to policies regarding notification of absence.
• Attends all mandatory management and staff meetings.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics and goals of the Company, Division and Group. 
• Maintains current licensure/certification for position, if applicable.
• Consistently demonstrates Guest Relation's skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact.
• Consistently follows Company, Division and Group Health, Safety, Security, Hazardous Materials policies and procedures.

Knowledge/Skills/Abilities/Expectations

• 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 70% of the time. 

Education

• Bachelors degree in business or related field required
• RN/ CCM preferred Masters degree preferred.

Licenses/Certifications

• CCM / Certified Case Manager through The Commission for Case Manager Certification- Preferred.

Experience

• Minimum ten years healthcare experience, including at least eight years experience in healthcare managed care business development.
• Minimum ofsix years experience in managed care contracting required.
• Knowledge of Post Acute Industry- Preferred.