Director Managed Care
Company: CHRISTUS Health
Location: Irving
Posted on: January 12, 2021
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Job Description:
Description Summary: The Director of Managed Care is responsible
for enhancing and maintaining managed care operations between the
CHRISTUS providers (Acute Care Hospitals, Physicians and Ancillary
providers) and managed care payors, including Medicaid and Medicare
managed care plans.Additionally, this position is responsible for
negotiating managed care contacts on behalf of a Region. This
position is accountable to work with corporate and regional staff
to ensure the accurate implementation, administration and ongoing
monitoring of managed care contracts and corresponding processes
and procedures at the facility and System level. This position will
lead or participate as part of the System negotiating team for all
state level contracts. A high degree of professionalism is required
due to the interaction with both internal and external (health
plans/payers) contacts. Leads and/or assists in the strategic
planning, analysis and negotiation of System and region specific
managed care contracts on an as-needed basis under the guidance of
the System Director or the Corporate VP Managed Care department.
Responsible as the managed care subject matter expert to the
assigned region. Develops and maintains relationships with staff of
managed care plans in the regions or corporate level of the
organizations. Directs staff in investigating and resolving managed
care reimbursement issues identified by PFS and/or payers,
including root cause issues including fee schedule and
reimbursement loading of contracts. Directs appropriate managed
care related education and training including roll out of new payor
contracts and new products (e.g. Marketplace-Health Insurance
Exchange products) Assures that new contracts are rolled out in a
timely, accurate manner. Assists in payor/plan dispute resolution
projects as appropriate. Negotiates one-time Letters of Agreement
and/or template for Regional use. Responsible for distribution of
managed care related information to hospitals, physician group
leadership, ancillary leadership and regions. Participates in
operational meetings with applicable payors as part of the
Corporate Managed Care department. Participates as part of System
negotiating team for system-wide or regional-level managed care
contracts. Knowledge of general Federal and applicable State
regulatory environment related to managed care and participates in
legislative advocacy activities as appropriate. Maintains strict
confidentiality. Uses oral and written communication skills to
effectively convey ideas in a clear, positive manner that is
consistent with the CHRISTUS Mission. Implements job
responsibilities in a manner that is consistent with CHRISTUS
Health Mission and Code of Ethics. Works with other CHRISTUS Health
departments to ensure accurate understanding of interconnectedness
of corporate and facility systems/processes/directives. Performs
other related work as assigned or required. Requirements: BA in
Business Administration or like degree required. Excellent written
and oral communication skills. Excellent organizational skills.
Excellent training skills. Ability to plan work schedule to meet
essential deadlines and targets. Possesses personal and
professional values consistent with those of CHRISTUS Health. At
least seven (7) years of experience in health care setting and/or
payor organizations with experience in contracting, claims
resolution, relationship development and staff education with a
managed care company or acute care hospital company. At least five
(5) years of experience managing staff. Work Type: Full Time
Keywords: CHRISTUS Health, Irving , Director Managed Care, Executive , Irving, Texas
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