Director Managed Care

• Leads and/or assists in the strategic planning, analysis and negotiation of System and region specific managed care contracts on an as-needed basis under the guidance of the System Director or the Corporate VP Managed Care department
• Responsible as the managed care subject matter expert to the assigned region
• Develops and maintains relationships with staff of managed care plans in the regions or corporate level of the organizations
• Directs staff in investigating and resolving managed care reimbursement issues identified by PFS and/or payers, including root cause issues including fee schedule and reimbursement loading of contracts
• Directs appropriate managed care related education and training including roll out of new Payor contracts and new products (e.g.. Marketplace-Health Insurance Exchange products)
• Assures that new contracts are rolled out in a timely, accurate manner
• Assists in Payor/plan dispute resolution projects as appropriate
• Negotiates one-time Letters of Agreement and/or template for Regional use
• Responsible for distribution of managed care related information to hospitals, physician group leadership, ancillary leadership and regions
• Participates in operational meetings with applicable payers as part of the Corporate Managed Care department
• Participates as part of System negotiating team for system-wide or regional-level managed care contracts
• Knowledge of general Federal and applicable State regulatory environment related to managed care and participates in legislative advocacy activities as appropriate

Bachelor's Degree required