Director, Managed Care

Qualifications 

• Education:

Required:  Bachelor'sdegree (minimum ten 10 years’ experience can be substituted for formal education). 

Desirable:  Master'sdegreeinhealthrelatedfield 

• Experience: 

-    Minimum seven (7) years in a Managed Care Contracting 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.

-    Experienceinanadministrativelyresponsiblepositionwithsignificantintra-departmentwork. 

-    Demonstratedinterpersonalskills. 

-    Demonstratedskillinworkingwithalargevarietyofpeopleofvariousorganizationsandlevels. 

-    Knowledgeoflegalterminology,understandingofgovernmentalandlegislativeregulations. 

-    Previousexperienceintheareasofmanagedcare/finance/or patientaccounting. 

-    Demonstratedabilitytoperformfinancialanalysis,including managed care contracting financial modeling. 

-    ComputerSkills:  FinancialModeling,Windows2000, Excel,2000,Work2000,PowerPoint. 

• SkillsandAbilities: 

EssentialJobResponsibilities 

• 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.
• Responsiblefortheinitialreadingandfinancialanalysisofmanagedcarecontractsforcontent,administrative issues,andappropriatefinancialreturn. 
• Evaluatefinancialperformanceofexistingcontractualrelationshipsandmonitorperformanceofnewcontractualrelationships.  Thisincludesproductionoffinancialimpactreports onanongoingbasisbybothPayorandmedicalgroup.
• Working closely with Managed Care and Finance leadership to develop contract proposals based on WHHS’ defined strategies, goals and objectives.
• 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.
• Preparehistoricalandfinancialdatatoprovidesupportfor contractnegotiationsandcontractrenewals. 

5.   Ensuring appropriate dissemination of contract details to all applicable stakeholders. 

• Alwaysensurestheaccuracyandcompletenessofallprojects, information,andanalysis. 
• Support WHHS RCM and Compliance with price transparency efforts and initiatives. 

1. DirectandoverseeContract Managertoperformmodeling,financialimpacts,utilizingFinancialPlanningandAnalysisdata basedonaproject-by-projectbasis. 

2. Developrecommendationsregardingratesandcontractlanguagefornewandrenewedcontracts. 

3. Administermanagedcarecontracts,aswellasdevelopandmonitortrackingandreportingmechanismstoensureappropriatereimbursementandadherencetocontractterms. 

4.   WorkwithallrelevantWashingtonHospitalHealthcareSystem computersystemstogarnerneededinformationforfinancialmodeling,tracking,analysis,customerrelations,etc. 

5. Workwithinternaldepartments,particularlyUtilizationManagementandPatientFinancialServices,toproactivelypromotemanagedcareandtoensureappropriateworkingrelationshipbetweenWashington HospitalHealthcareSystemsandPayor/medicalgroups. 

6. StandinforChief Revenue Officerwhenneededatintra-hospitalandexternalhospitalmeetings. 

7.  Alwayscomplieswithestablisheddepartmentpoliciesandguidelinesindevelopingprojects,informationandanalysis. 

8. Consistentlychallengestheappropriatenessofassumptionsandformulasusedinthepreparationofallprojects,informationandanalysis. 

9. Consistentlymonitorsthemonthlymanagedcaredatafrominformationsystemsandtakesappropriatefollow-upactions. 

Planning& 

Coordinating 

1. Resolveclaimsissueswithcontracted Payorsandmedicalgroups. 

2. Develop,monitorandperformtrainingforallpatientintakeWashington HospitalHealthcareSystememployeestoensurecorrectPayor/medicalgroupidentificationandtracking,andotherissuesinmanagedcare.