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Corporate Director of Managed Care Contracting

  • Mechanicsburg, PA
  • Direct Hire
  • Job ID: NC107-2695118

Job Summary

Responsible for planning, analysis, negotiation, and implementation for new and renegotiated contracts for assigned hospital portfolio.  Serve as corporate liaison for Operation and Business Development leaders as well as key corporate functional support areas.   This position will focus on increasing net revenue through favorable contracts that exceed our costs to provide care as well as on capturing maximum referral volume from each executed contract and increasing out of network volume wherever feasible.  Serve as contracting leader for new hospital integration and consolidations/closures.

Essential Functions

  • Analyze, negotiate, and implement new and renegotiated contracts for assigned hospital portfolio.  Develop payor strategies to ensure optimal contracting and operational performance for hospitals. 
    • Responsible for rate and payment methodologies, contract language, as well as following all internal controls for contract review and administration, approval, and signature.
    • Manage implementation of new contracts/renegotiations/physician agreements.
    • Manage and act as corporate liaison for assigned regional and national contracts.
    • Oversee credentialing/re-credentialing and billing/reimbursement development.
    • Ensure COLA’s are administered in accordance to contract terms.
    • Complete and execute Single Case Agreements.
  • Liaison between DBD’s, CEO’s, CBO, and Payor Provider Relations staff, to assure that the requirements of a contract can be implemented and maintained.
    • Coordinate contracting efforts in conjunction with business development initiatives.
    • Develop and implement roll-out of new contracts including post analysis reports.
    • Assist DBD’s and CEO’s in detail review and the analysis of actual-to-expected payor rate per patient day reimbursement for current contracts.
    • Assist with Billing office reimbursement projects and issues.
    • Lead role for key payor meetings and issues/resolution tracking.
  • Serve as Hospital, payor relations, admissions, and case management support.
    • Promote use of Contract Information System and other tools.
    • Develop and maintain positive payor relations, identify and address issues.
    • Respond to inquiries and issues for new and renegotiated contracts.
    • Regularly review insurance verifications at request of hospital staff.
    • Coordinate information and analysis requests from corporate case management.
  • Ensure Critical Illness Recovery Hospitals maximize utilization of contracts.
    • Participate in new employee orientation of Director for Business Development and others.
    • Obtain payor contacts for new contracts to establish initial and ongoing meetings.
    • Chair quarterly trend report calls and disseminate market findings/opportunity and track post meeting action items and status.
    • Coordinate meetings with hospitals to resolve payor and/or volume issues, market consolidations, and closures as requested.
  • Business Development and Integration.
    • Evaluate JV and Acquisition opportunities to help Operations and Finance conduct due diligence.
    • Oversee contract and credentialing implementation for new hospital openings/closures/mergers, JV’s, and acquisitions.
    • Develop and follow an integration plan – lead post close integration payor contract coordination with Operations and Shared Services
  • Set goals and objectives each fiscal year with Senior Director, and provide guidance in accordance with department objectives, policies, and procedures. 

Additional Responsibilities

  • Perform other duties and special projects as assigned by the Vice President Payor Contracting or company President.

Required Credentials

  • Bachelor’s degree or higher preferred or equivalent work experience.
  • 3-5 years demonstrated experience in a managed care setting, hospital setting, preferably working in contracting or provider relations arenas
  • Required Abilities
    • Ability to develop or refine internal and external processes to ensure optimal efficiency and ease of administration of new and existing contracts and to implement changes, in collaboration with other affected functions to ensure a high quality and effective process.
    • Excellent leadership skills to include: organizing work, coaching, motivating and developing staff
    • Strong project management skills.  Strong attention to details, timelines and follow-through
    • Collaborative and positive manner
    • Ability to interact and work with all levels of management
    • Creative problem solving skills. Ability to anticipate needs and be proactive in planning and execution.  Flexible and adaptable to change
    • Strong verbal and written communication skills
    • Ability to work independently and with minimal instructions and supervision.  Ability to prioritize and complete multiple projects in the most effective/results oriented order
    • Required to be proficient in Windows-based office technologies (Word, Excel, ACCESS, Power Point)
    • Strong medical terminology and knowledge of the managed care/provider business environment
    • Ability to handle multiple tasks simultaneously and to cope with internal and external pressure to complete such tasks in a timely manner
    • Willingness and ability to travel as needed for payer interactions, relationship building and on-site training
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