Director, Managed Care

Responsible for overall operational effectiveness of team. Actively assists VP with managed care contracts and negotiations. Develops a communication process due to issues, problems and concerns across the system and leads both internal and external discussions to get issues resolved.

Key Accountabilities:

• Responsible for overall integrity and effectiveness of software system, load, audits and communications with Vendor.
• Participates actively in negotiations and administration of contracts. Including but not limited to: auditing contract simulations, review of and assisting VP with contract language, providing input and ideas into methodology, ensuring processes are in place to minimize problems that may occur with contracts while assisting all departments with concerns.
• Responsible for coordination and facilitation of issues and concerns across system for all managed care/third party. Includes but not limited to: oversight of monthly meetings with all payors, coordination of issue logs, central point of contact for regarding payors for all areas: hospitals, physicians, CPA lab, behavioral health and pharmacy.
• Responsible for management and supervision of team.

Required:

• Three years in managed care or revenue cycle
• Bachelor Degree

Desired:

• One year in third party payor contracting
• Master Degree