Job Description

Primary Accountability

The Director of Managed Care is responsible for negotiating and maintaining a portfolio of managed care and other third party payer contracts to enhance revenue and support the overall financial goals and strategic objectives of the company.

Description Of Primary Responsibilities

• Provides overall management and direction to departmental/division staff
• Responsible for performance management of departmental employees, including all managers, supervisors, and employees in the department, including recognition, performance evaluations, formal coaching and counseling, and making decisions or recommendations regarding necessary disciplinary actions.
• Responsible for recommending hiring or firing, and the advancement and promotion of managers, supervisors, and employees in the department, or any other change status of manager, supervisors, and employees in the department employees.
• Demonstrates core leadership behaviors and team one approach.
• Demonstrates a high level of emotional intelligence.
• Creates a culture of accountability and excellence.
• Drives execution and innovation.
• Ensures division alignment with organizational culture and strategic vision.
• Ensures development of and successful execution of an action plan across assigned employee base to support the strategic direction of the organization and obtainment of operational goals for assigned departments/division, effectively leading change when necessary.
• Empowers staff through effective communication and talent development.
• Ensures team members of all assigned areas of responsibility are fully functional and performing at a world-class level.
• Ensures development of department/division managers and supervisors receive instruction/training that is in compliance with training plan, including on the job training to develop department employees. Works with manager and/or supervisor to ensure necessary remediation is taken with department/division employees assigned.
• Assists with the development of assigned departmental/division budget(s) and monitors budget to ensure expenses do not exceed budget.
• Ensures regulatory compliance for assigned departments/divisions, and compliance with all workflows, policies, and procedures.
• Recommends workflow, policy, and procedure changes based on observations from performance metrics, outcomes, and feedback from assigned leadership team members.
• Ensures department maintains compliance with all employee related reporting and tracking.
• Responsible for the development, management and implementation of managed care activities and initiatives for Medi-Cal, Medicare, and commercial insurances.
• Assess the viability of managed care contracts as the health care landscape evolves over time.
• Coordinates with health plans to develop customized reports which include financial, demographic, medical, and utilization data.
• Develops and maintain effective business relationships with insurance company and key health system partners responsible for contracting with healthcare providers.
• Publishes reports to track progress towards any incentive, clinical, or strategic goals related to managed care.
• Works with the billing department as needed to resolve issues that arise when rates received by payors vary from the contract.
• Responsible for the credentialing and provider enrollment function.
• Responsible for Medicare Accountable Care Organization (ACO) activities that support delivery care transformation
• Manages multiple current ACO initiatives in conjunction with the ACO administrative organization (Aledade).
• Ensures that FHCN meets it quality and cost goals, as defined by the ACO, by facilitating communication between departments involved.
• Responsible for the negotiation of managed care and other contracts with health plans including the language, rates, and amendments.
• Monitors financial status of contracts and makes recommendations for amendments and changes to lessen the organization’s financial, legal, and operational risks.
• Facilitates analysis of operational, financial, and clinical data to identify opportunities for developing programs and initiatives that promote success in value-based payment arrangements.
• Assists in the analysis of clinical and operating costs and their application in the health centers to maximize system efficiencies.
• Identifies opportunities to grow the company’s managed care business through various avenues including adding lives, new lines of business, or assumption of risk.
• Establishes and maintains policies and procedures to assist the network in maximizing contract provisions and incentives with health plans.
• Identifies and facilitates managed care training needs of health center staff.
• Works with other departments to facilitate changes to workflows, templates, visit types, etc. that may influence managed care contract related outcomes such as quality measures or incentives.
• Assists in the analysis of clinical and operating costs and their application in the health centers to maximize system efficiencies.
• Performs other duties as assigned.
  

Description Of Primary Attributes

Professional & Technical Knowledge:

• Possesses specific advanced knowledge and skills, including written and verbal communication skills, computational, computer and technical skills, and mathematical knowledge frequently acquired through completion of a Bachelor’s Degree or Master’s Degree program with a Business, Healthcare or Public Administration major or comparable experience, and;
• Six years of leadership experience or seven years of progressively greater responsibility or significant contributions to projects and initiatives that demonstrate leadership skills.
• At least three years of a managed care environment experience required, with emphasis on financial management aspects of IPA or HMO setting preferred.
  
  

Technical Skills

• Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements.
• Ability to use Microsoft Excel to analyze data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements.
• Ability to develop sophisticated presentations in Microsoft PowerPoint, including the use of embedded objects, transitions and other elements.
  
  

Licenses & Certifications: None required.

Communications Skills

• Job duties require the employee to effectively communicate, verbally and in writing, their opinions and extrapolations of information they collect and synthesize/analyze.
• Responsible for the resolution of conflicts that may arise because of disagreements between employees, between employees and customers/clients, or with the public, other legal entities or governmental authorities.
• Compiles, analyzes and prepares information in an effective written form, including correspondence, reports, articles or other documentation.
• Effectively conveys technical information to non-technical audiences.
  
  

Physical Demands: The physical demands described in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this position, the employee is regularly required to sit and type. The employee is frequently required to stand or walk and lift/move items weighing up to 10 Ibs.

Pay Scale

Min Salary Rate: $132,653.83

Max Salary Rate: $212,246.12