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Director of Managed Care Contracting - Outpatient Division

  • Mechanicsburg, PA
  • Direct Hire
  • Job ID: NC107-2700821

Job Summary

Responsible for planning, analysis, negotiation, and implementation of new and renegotiated contracts for assigned clinics and markets.  Serve as key corporate liaison for Operations and Finance leaders as well as 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 clinic acquisitions and JV clinic integrations.

Essential Functions

  • Analyze, negotiate, and implement new and renegotiated contracts for assigned clinic portfolio.  Develop payor strategies to ensure optimal contracting and operational performance for assigned markets. 
    • Responsible for rates, payment methodologies, contract language, following all internal controls for contract review, approval, and signature.
    • Manage implementation of new contracts and renegotiations.
    • Manage and act as corporate liaison for Regional/National contracts as assigned.
    • Work with Credentialing Department (Delegated and Non-Delegated) to review Delegated Credentialing agreements and setup credentialing requirements for newly contracted payors.
    • Ensure negotiated COLA’s are in effect.
    • Complete and execute Single Case Agreements in accordance with SVP Operations approval guidelines.
  • Corporate Liaison for Operations and key support functions.
    • Implement new contract rollouts and post rollout analysis.
    • Work closely with designated Director(s) of Finance regarding changes (positive and negative) impacting reimbursement, discuss strategies to enhance NRPV and contract performance.
    • Work with Legal, Regulatory, and Clinical Services on an as needed basis for contract related questions or issues.
    • Provide support for Finance and Legal for decision support and contract performance.
    • Participate in key payor meetings acting as lead liaison and issues tracking
    • Assist Revenue Cycle Managers and CBO with contract related questions or issues.
  • Clinic and Payor Relations
    • Promote use of Contract Information Systems and other tools.
    • Develop and maintain positive payor relations, identify and address issues.
    • Respond to inquiries/issues for new and renegotiated contracts.
  • Ensure Clinics maximize utilization of contracts
    • Participate in new employee orientation of clinical leaders/support staff.
    • Obtain payor contacts for new contracts to establish initial and ongoing meetings.
    • Chair quarterly trend report calls and disseminate market trend findings/opportunity and track post meeting action items and status.
    • Coordinate meetings with clinic Operations leaders and resolve payor and/or volume issues, and market consolidations as requested.
  • Business Development and Integration
    • Oversee contract implementation for new clinic openings/mergers, JV’s, and Acquisitions.
    • Work closely with Credentialing department to assure payor credentialing requirements have been met.
    • Develop and follow integration playbook – update progress and communicate to Outpatient leader of Integration Effort/Coordination.

Additional Responsibilities

  • Perform other duties and special projects as assigned.

Required Credentials

  • Bachelor’s degree or higher preferred or equivalent work experience.
  • 3-5 years demonstrated experience in a managed care setting, Outpatient Services setting, preferably working in contracting or provider relations areas.
  • 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.
    • 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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