Director, Managed Care

Director, Managed Care Contracting

The Director, Managed Care Contracting, contributes to WHHS' growth and profitability by providing contracting expertise to existing and new contractual relationships; and providing subject matter expertise, guidance, and direction regarding Managed Care Contracts. This includes coordination of commercial, Medicare Advantage, Medi-Cal Managed Care, Value-Based, Medicare Shared Savings, and other third party managed care contracts and Payor relation activities for Washington Hospital, Washington Township Medical Foundation, and DEVCO entities (surgery centers and other ancillary entities). The Director will be responsible for overseeing administration, review, and financial analyses of managed care contracts for the healthcare system, performing financial reporting and financial modeling for senior management strategic managed care decision-making, and overseeing all Payor relations and managed care denial follow-up and resolution activities for the health care system.

Qualifications:

• Education: Required: Bachelor's degree (minimum ten years' experience in education, licensure, work experience, skills/computer/specific technical can be substituted for formal education). Desirable: Master's degree in health related field
• Experience: Minimum seven (7) years in a Managed Care Contracting miscellaneous capacity within a health plan or hospital; and at least five (5) years of experience managing and mentoring Contract Manager or Payor Relations representatives.
• Skills and Abilities: Must possess technical and professional skills and knowledge of finance, patient accounting functions and managed care. Must possess strong interpersonal skills, be an effective public speaker and be comfortable in working with diverse groups of individuals. Must be able to competently represent Washington Hospital at administrative functions. Must be able to work independently and creatively.

Essential Job Responsibilities:

• Responsible for negotiating Managed Care Contracts.
• Responsible for the initial reading and financial analysis of managed care contracts for content, administrative issues, and appropriate financial return.
• Evaluate financial performance of existing contractual relationships and monitor performance of new contractual relationships.
• Working closely with Managed Care and Finance leadership to develop contract proposals based on WHHS' defined strategies, goals and objectives.
• Prepare historical and financial data to provide support for contract negotiations and contract renewals.
• Ensuring appropriate dissemination of contract details to all applicable stakeholders.
• Always ensures the accuracy and completeness of all projects, information, and analysis.
• Support WHHS RCM and Compliance with price transparency efforts and initiatives.