Director, Managed Care

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



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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.



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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.



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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.



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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



prep