Director of Managed Care

Location
Gaithersburg, MD
Posted
Feb 05, 2018
Closes
Mar 03, 2018
Function
Executive, Director
Industry
Healthcare
Hours
Full Time
AdvertisementAdventist Healthcare

Care. Compassion. Community.

Responsibilities

Responsible for overseeing the strategic planning, negotiation and execution of managed care contracts for Adventist HealthCare and Management of Third Party Payer relations.

Serve as lead for contracting for all Adventist HealthCare entities including 2 acute care hospitals, one rehabilitation hospital (including rehabilitation outpatient sites), home health agency, behavioral health hospital & behavioral health outpatient sites, urgent care centers, pathology lab, radiology/imaging centers, employed physician group and clinically integrated network.

Strategy development includes market assessment, financial modeling, and relationship management w/employers and payers.

Responsible for developing and maintaining positive working relationships with all payers and for resolving third-party payer dispute issues that may arise pursuant to contractual relationships with payers.

Responsible for Facility Credentialing and Enrollment required for commercial contracting and enrollment with government payers.

Responsible for negotiating single case agreements when needed for patients who present for services with non-contracted payers.

Responsible for reconciliation and negotiation of MD Working Capital with payers.

Provide internal and external consultation regarding managed care, reimbursement strategies, and relationships to the Managed Care dept. and executive leadership across integrated delivery system

Development of the necessary system to support the data gathering and data analysis needs of managed care contracting

Work with financial departments of all entities to ensure target contract rates meet costs/operating margin needs of entities.

Responsible for negotiating contract which includes assessing legal and financial implications of all contracting opportunities.

Develops strong relationships with internal clinical providers and groups, Patient Financial Services and all departments impacted by contracts and contract terms.

Responsible for Dissemination of pertinent contractual terms, payer policies/procedures and payer regulatory updates across the Adventist Health system.

Qualifications

Minimum 10 years Managed Care Contracting experience either in a Health System, Physician Group or Payor. Experience to lead Maryland HSCRC negotiations as well as outside of Maryland, non-HSCRC negotiation experience for hospitals. Ten (10)-years or more progressively responsible experience in finance, data analysis and strategic analysis.

Bachelor's degree in Business Administration, Finance, Healthcare Administration, or related field required. J.D., MBA and/or MHA a plus.

Tobacco Statement

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, We will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.

We will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.

Equal Employment Opportunity

We are an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Learn More

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