Managed Care Director

Job Summary: The Director of Managed Care is responsible for Managed Care contracting with various payor organizations with the primary goal to increase revenue and market share through the acquisition of profitable managed care contracts. The Director of Managed care oversees contract negotiations with all managed care plans across the Anderson Healthcare system while ensuring that contracts within all entities are compliant and in the right networks. Service and Quality Standards: Service Is Customer focused Anticipates customer needs Adheres to customer service standards Is Competent, caring and compassionate Treats coworkers and customers with dignity and respect Demonstrates competent, caring and compassionate behavior to customers and coworkers People Is conversation conscious Assures confidentiality of patient and employee information Is positive in interactions with others Is courteous and respectful Promotes a harassment free environment Inspires the trust of others Acts in accordance with hospital policies, meets the requirements of the Code of Conduct, and identifies any conflicts of interest. Quality Is excellent in patient care and service Demonstrates multidisciplinary cooperation Assists in obtaining excellent satisfaction scores of feedback Is safety conscious Demonstrates safety consciousness and supports safety initatives Is involved with improvement efforts Supports performance improvement Seeks ways to improve systems and services Shows commitment to improvement efforts Meets mandatory educational requirements Growth Is a loyal ambassador Demonstrates commitment to hospital mission and vision Is active and involved Supports hospital initiatives Champions innovation and supports change Is a positive role model Fosters team cooperation Finance Is a good steward of hospital resources Develops/uses efficient work methods Is cost effective Conserves organizational resources Job Responsibilities: Responsible for all Managed Care contracting with various payor organizations with the primary goal to increase revenue and market share through the acquisition of profitable managed care contracts. Oversees contract negotiations with all managed care plans across the Anderson Healthcare system. Reviews all contracts annually for rate increase compliance and ensures that all entities are in the right networks. Responsible for developing and maintaining relationships with payors in order to increase referrals, including identifying, seeking and securing new opportunities. Manages day-to-day managed care operations and contracting activities. Develops and implements a managed care strategy for management and its entities. Represents organization and its entities in all managed care contract negotiations and is responsible for going into the negotiation process prepared with goals and objectives for the contract outcomes. Responsible for ensuring entities at all levels of the organization will be informed about any and all terms of negotiated contracts and understand their role in ensuring contracts are implemented quickly and correctly. Prepares all financial models for all payer negotiations of the organization to the approval of CFO. Ensures best interest are met, involving legal counsel if and when necessary. Seeks and obtains additional managed care contracts as a result of establishing contacts and developing professional relationships with existing and potential payors. Identify, analyze and develop potential joint marketing strategies with managed care payers and other providers for the benefit of the organization. Coordinates all facility entities credentialing and notifications with various payor organizations. (example; chargemaster notification, hospital based listings, new locations, etc.) Coordinates payor operation meetings with all entities of the organization as requested or needed and communicate payor information to Revenue Cycle staff. Works with internal departments on denial management with payor organizations. Maintains database of contact rates and key account information. Qualifications Education Requirements and Other Requirements: Education Level: Bachelor's degree in Business related field Certification/Licensure: N/A Experience Requirements: 5+ years in Managed Care experience