Managed Care Director

Job Title

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

Day Shift - 7.5 Hours (United States of America)

Key Responsibilities

1. Contract Management:

Perform full life-cycle Contract Management for a portfolio of managed care contracts

Develop administrative and technical contracting strategies through development, negotiation, implementation of terms, and monitoring contractual agreements on behalf of the Richmond University Medical Center and Richmond Health Network

Review, interpret, analyze, manage, negotiate complex agreements, resolve contractual issues, and ensure adherence to all contract language, financial guidelines, and parameters

Ensure compliance with contract terms and conditions

Monitor and analyze contract performance, addressing any issues or discrepancies

Develop and maintain processes to provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements)

2. Financial Oversight:

Develop and implement strategies to maximize reimbursement and minimize denials

Monitor financial performance, including budgeting, forecasting, and variance analysis

Collaborate with the finance department to ensure accurate billing and coding practices

Track and maintain financial performance and status for all contracts to monitor and coordinate financial analysis of payer contract performance and modeling projections

3. Operational Leadership:

Provide direction and supervision to assigned department staff in areas of contracting, contract management and provider relations

Assist in producing and disseminating contract information to all relevant departments, identify and resolve problems with contracts regarding billing, claims payment, scheduling, registration, credentialing, service development, care management, and noncompliance

Lead and manage the managed care department, including hiring, training, and performance evaluation of staff

Develop and implement policies and procedures to streamline managed care operations

Coordinate with clinical and administrative departments to ensure seamless patient care delivery

Support the entire contract process and closely collaborates with internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers

4. Quality and Compliance:

Ensure compliance with all relevant regulations, standards, and guidelines (e.g., CMS, state regulations)

Implement quality improvement initiatives to enhance patient care and operational efficiency

5. Relationship Management:

Serve as the primary liaison between the hospital and MCOs, insurance companies, and other payers

Foster positive relationships to enhance collaboration and problem-solving

Represent the hospital in managed care meetings and negotiations

Act as a liaison with Patient Financial Services, physician offices and health plans to resolve contractual issues and ensure compliance with negotiated contractual terms

6. Strategic Planning:

Develop and execute strategic plans to improve managed care operations and support the hospital's overall goals

Stay abreast of industry trends and best practices, implementing changes as needed

Participate in strategic planning and decision-making processes at the executive level

Qualifications

Bachelor's degree in healthcare administration, Business Administration, or a related field (Master's degree preferred)

5+ years' contracting experience with hospital, clinic, physician, and or health system require

3+ years' experience with medical insurance company, MSO, IPA, TPA, preferred

Strong knowledge of managed care principles, healthcare regulations, and reimbursement methodologies

Excellent negotiation, communication, and interpersonal skills

Proven ability to analyze financial data and develop strategic plans

Leadership skills with a track record of building and managing effective teams

Proficiency in healthcare management software and Microsoft Office Suite

Salary Range: $170,000 - $180,000

Employment Non-Discrimination: Richmond University Medical Center is committed to equality of opportunity in all aspects of employment and provides full and equal employment opportunities to all employees and potential employees without regard to race, color, national origin, religion, gender identity, sex, sexual orientation, pregnancy, childbirth and related medical conditions and needs including lactation accommodations, physical or mental disability, age, immigration or citizenship status, veteran or active military status, genetic information, or any other legally protected status.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!