Director, Managed Care

Washington Hospital

Fremont, California

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JOB DETAILS

SKILLS

Analysis Skills, Communication Skills, Computer Systems, Contract Analysis, Contract Approval, Contract Creation, Contract Management, Contract Negotiation, Contract Research Organization (CRO), Customer Relations, Customer Support/Service, Data Collection, Data Management, Develop Methodologies, Executive Assistant Skills , Finance, Financial Analysis, Financial Management, Financial Modeling, Financial Planning and Analysis (FP&A), Financial Reporting, Financial Services, Government Regulations, Health Plan, Healthcare, Healthcare Administration, Healthcare Quality, Hospital, Hospital Administration, Hospital Systems, Information Technology & Information Systems, Interpersonal Skills, Leadership, Legal, Managed Care, Medi-Cal, Medical Billing, Medical Office, Medical Records, Medicare, Mentoring, Microsoft Excel, Microsoft PowerPoint, Organizational Skills, Patient Admissions, Performance Analysis, Performance Management, Plan Meetings, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Profit & Loss, Project Development, Project Evaluation, Proposal Development, Quality Assurance, Reimbursement, Return on Investment (ROI), Time Management, Training/Teaching, Utilization Management

LOCATION

Fremont, California

POSTED

30+ days ago

Description

Salary Range: $196,000.00 - $294,000.00

Washington Hospital Healthcare System Job Description

Job Code: 714

The Director, Managed Care Contracting, contributes to WHHS’ growth

Job Title: Director, Managed Care Contracting

Position Summary

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. In addition to performing the

essential functions listed below, may also be assigned other duties as

required.

Statement of

Reports to: Vice President & Chief Revenue Officer

Accountability

JobDescriptionTemplate Revised10/13/24

Qualifications

1. Education:

Required: Bachelor's degree (minimum ten 10 years’ experience

•

Education

Licensure

Work Experience

Skills/computer/ specific

technical

can be substituted for formal education).

Desirable: Master's degree in health related field

2. Experience:

1. Other qualifications,

Minimum seven (7) years in a Managed Care Contracting

miscellaneous

capacity within a health plan or hospital; and at least the five

(5) years of experience managing and mentoring Contract

Manager or Payor Relations representatives.

Specify if qualifications are

Required or Preferred

Experience in an administratively responsible position with

significant intra-department work.

Demonstrated interpersonal skills.

Demonstrated skill in working with a large variety of

people of various organizations and levels.

Knowledge of legal terminology, understanding of

governmental and legislative regulations.

Previous experience in the areas of managed

care/finance/or patient accounting.

Demonstrated ability to perform financial analysis,

including managed care contracting financial

modeling.

Computer Skills: Financial Modeling, Windows 2000,

Excel, 2000, Work 2000, PowerPoint.

3. 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.

JobDescriptionTemplate Revised10/13/24

Essential Job Responsibilities

Achieving Results

Key Components: assess,

plan, evaluate, demonstrate

initiative, quality of work,

productivity

1. Responsible for negotiating Managed Care Contracts. This

includes routine contracting activities, maintaining strategic

relationships, evaluating contracts, and acting as an internal

resource in interpreting contracts.

2. Responsible for the initial reading and financial analysis of

managed care contracts for content, administrative issues, and

appropriate financial return.

3. Evaluate financial performance of existing contractual

relationships and monitor performance of new contractual

relationships. This includes production of financial impact reports

on an ongoing basis by both Payor and medical group.

4. Working closely with Managed Care and Finance leadership to

develop contract proposals based on WHHS’ defined strategies,

goals and objectives.

5. Working closely with WHHS Strategy to participate in Employer

Direct contracting, contracting for new WHHS services, and other

strategic growth initiatives that require managed care contracting

support.

6. Prepare historical and financial data to provide support for

contract negotiations and contract renewals.

5. Ensuring appropriate dissemination of contract details to all

applicable stakeholders.

6. Always ensures the accuracy and completeness of all projects,

information, and analysis.

7. Support WHHS RCM and Compliance with price transparency

efforts and initiatives.

JobDescriptionTemplate -Revised10/13/24

Demonstrates Skill

KeyComponents:

competency, job knowledge,

organizational skills,

1. Direct and oversee Contract Manager to perform modeling,

financial impacts, utilizing Financial Planning and Analysis data

based on a project-by-project basis.

analytical skill, management

of information, employee &

patient safety

2. Develop recommendations regarding rates and contract language

for new and renewed contracts.

3. Administer managed care contracts, as well as develop and

monitor tracking and reporting mechanisms to ensure

appropriate reimbursement and adherence to contract terms.

4. Work with all relevant Washington Hospital Healthcare System

computer systems to garner needed information for financial

modeling, tracking, analysis, customer relations, etc.

5. Work with internal departments, particularly Utilization

Management and Patient Financial Services, to proactively

promote managed care and to ensure appropriate working

relationship between Washington Hospital Healthcare Systems

and Payor/medical groups.

6. Stand in for Chief Revenue Officer when needed at intra-hospital

and external hospital meetings.

7. Always complies with established department policies and

guidelines in developing projects, information and analysis.

8. Consistently challenges the appropriateness of assumptions and

formulas used in the preparation of all projects, information and

analysis.

9. Consistently monitors the monthly managed care data from

information systems and takes appropriate follow-up actions.

10.Provides sound, effective advice to management to assist them in

making effective decisions regarding managed care and strategic

issues surrounding managed care.

JobDescriptionTemplate -Revised10/13/24

Demonstrates Skill

Cont'

11.Always exercises care and accuracy in conducting collection and

analysis studies.

12. Takes resourceful/creative approach in collecting data, conducting

research, developing methodology and deriving conclusions and

recommendations.

Planning &

Coordinating

1. Resolve claims issues with contracted Payors and medical

groups.

Key Components: delegates,

decision making, problem

solving, management of

resources

2. Develop, monitor and perform training for all patient intake

Washington Hospital Healthcare System employees to ensure

correct Payor/medical group identification and tracking, and other

issues in managed care.

3. Design, conduct and coordinate meetings with physician office

managers to provide training in areas of managed care.

Professionalism

1. Consistently provides clear and thorough information in the

preparation of all projects, information, and analysis

Key Components:

dependability, interpersonal

skills, teamwork, patient first

ethic, customer service,

communication skills,

punctuality/attendance,

receptiveness to criticism,

judgment, confidentiality

2. Always displays study findings in a clear, organized format, and

prepares written communication/reports in a clear, concise and

organized fashion.

3. Consistently meets scheduled time frames in preparing all

projects, information, and analysis.

4. Consistently responds to inquiries from management regarding

information established from all projects and analysis.

5. Demonstrates good judgment when communicating with

patients/customers of various age groups by modifying delivery

and complexity of information based on age.

Improving the

Organization

1. Regularly identifies system enhancement opportunities and

recommends appropriate changes.

Key Components:

performance improvement,

quality initiatives

2. Participates in multidisciplinary performance improvement

activities.

3. Identifies opportunities for improvement in managed care

contracting and relationships through direct input from affected

departments, including registration, patient accounting, billing,

utilization management, medical records, and quality

improvement.

4. Participates in improving service by serving on committees or task

forces, collecting data when appropriate, and sharing ideas for

improvement.

5. Serves on Process Improvement Teams as requested.

JobDescriptionTemplate -Revised10/13/24

Self-Development

Key Components: maintain

license/certification,

1. Attends at least one educational program each year (i.e. HFMA,

Becker’s or applicable other as approved by Chief of Payor Contracting).

education and training

Regulatory

Compliance

Key Components: JCAHO,

Title 22, OIG, HIPAA,

State/Federal laws, hospital

policies

1. Demonstrates awareness of, and compliance with, patient safety

and regulatory and licensing standards; i.e., TJC, Title 22,

OSHA, HIPPA and Washington Hospital's numbered

memorandums.

Prepared by: Semone Clark

Approved by: Marcus Watkins

Personnel Office Review:

Revised Date:

Title: Executive Assistant III

Title: VP & CRO

Date: 10/13/2024

Date: 5/4/2026

Date:

JobDescriptionTemplate-Revised10/12/04

Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.

About the Company

Washington Hospital

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