Director of Managed Care Contracting

Community Care Network of VA
Henrico County, VA
Jul 17, 2017
Jul 17, 2017
Executive, Director
Full Time
Reports to: Chief Executive OfficerA' SUMMARY: This position is primarily responsible for the development, implementation and coordination of managed care contracting and related activities for CCNV Network under the direction of the CEO. The Director of Managed Care Contracting will lead the execution of CCNV's contracting strategy to optimize relationships with health plans and other payors in a manner consistent with CCNV's contract strategy.A' ESSENTIAL DUTIES AND RESPONSIBILITIES: Manage assigned portfolio of Payor contracts and relationships for all network contracts. Develop Payor strategies to ensure an optimal contracting and operational outcome for CCNV providers, advocating on behalf of the CCNV providers as issues, opportunities or disputes arise. Responsible for negotiating contracts with managed care Payors on behalf of CCNV providers, including preparation of contracts for contract language, value based and shared /full risk payment programs, following all internal controls for contract review, approval and signature in alignment with CCNVs vision, goals and objectives. Liaison to Payors and operational areas within the network, with a focus on promoting proactive, professional and collaborative relationships, problem resolution and avoidance of future issues whenever possible. Works closely with the Director of the Central Business Office and Credentialing Services to get information regarding contract operations. Promote enhanced use of available contract management tools to support contract negotiations, revenue recovery and contract performance, providing support to decision support, finance, clinical and network leadership on managed care issues. Work with CCNV staff and network members to successfully engage the top health plans in Virginia to contract with and send substantial volume of membership to CCNV centers. Review all contract provisions, via tracking of performance through a variety of means, including audit of current performance via claims review, reports, etc. Develop and implement, in conjunction with the Executive Committee an annual operating plan and managed care strategic plan. Analyze and estimate financial impact of managed care contracts as requested by CCNV Executive Committee. Oversee managed care compliance efforts. Maintain and update permanent record of all major payor contracts for respective service center market. Administer protocols to ensure smooth and timely implementation of contract terms. Prepare monthly reports to summarize managed care negotiation activities in the Division/Market/Practice. Analyze performance and provide evaluation on all existing contracts to operations management annually and/or as requested. Maintain knowledge of Virginia and federal legislative and regulatory laws and rules regarding managed care. Establish documented process of negotiating, implementing, and managing all third party contracts. Review new contracts and changes to existing contracts. Pinpoint and resolve contracting issues and payer disputes. Perform other duties as assigned by supervisor.A' A' COMPLEXITY OF WORK: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Strong technical, financial and negotiation skills. Extensive managed care insurance and hospital industry knowledge. QUALIFICATIONS: Bachelor's degree in related field. A Master's Degree is highly desirable.A' REQUIRED WORK EXPERIENCE: 7 years managed care contracting experience with emphasis on facility contracting. Richmond Times-Dispatch. Keywords: Contract Negotiator, Location: Henrico, VA - 23233