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 Contractin

g

Position Sum

mary

The Director, Managed Care Contracting, contributes to WHHS’ growth 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 A

ccountability

Reports to

Vice President & Chief Revenue Officer

Qualifications

Education

Required

Bachelor's

degree (minimum ten 10 years

’

experience can be substituted for formal education).

Desirable

Master's

degree

in

• health
• related
• field

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.

-

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.

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.

Essential

Job

Responsibilities

• 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.

Responsible

for

the

• initial
• reading

and

• financial
• analysis

of

• managed
• care
• contracts

for

• content,
• administrative issues,

and

• appropriate
• financial
• return.

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.

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.

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.

Always

ensures

the

accuracy

and

completeness

of

• all
• projects, information,

and

• analysis.
• Support WHHS RCM and Compliance with price transparency efforts and initiatives.

Demonstrates

Skill

1. Direct

and

oversee

Contract Manager

to

• perform
• modeling,
• financial
• impacts,
• utilizing

Financial

Planning

and

Analysis

data based

on

a

• project-by-project
• basis.

1. Develop

• recommendations
• regarding
• rates

and

• contract
• language

for

new

and

• renewed
• contracts.

1. 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.

1. 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.

1. 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.

1. Consistently

challenges

the

appropriateness

of

assumptions

and

• formulas
• used

in

the

preparation

of

• all
• projects,
• information

and

analysis.

1. 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.

1. Always

• exercises
• care

and

accuracy

in

• conducting
• collection

and

• analysis
• studies.

1. 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.

1. 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

1. Always

• displays
• study
• findings

in

a

• clear,
• organized
• format,

and

• prepares
• written
• communication/reports in

a

• clear,
• concise

and

• organized
• fashion.
• 3.

Consistently

• meets
• scheduled
• time
• frames

in

• preparing
• all
• projects,
• information,

and

• analysis.
• 4.

Consistently

responds

to

• inquiries
• from
• management
• regarding
• information
• established
• from
• all
• projects

and

• analysis.
• 5.

Demonstrates

• good
• judgment
• when
• communicating
• with patients/customers

of

• various
• age
• groups
• by
• modifying
• delivery

and

complexity

of

• information
• based

on

age.

Improving

the

Organization

1. Regularly

• identifies
• system
• enhancement
• opportunities

and

• recommends
• appropriate
• changes.

1. Participates

in

• multidisciplinary performance
• improvement
• activities.
• 3.

Identifies

opportunities

for

improvement

in

• managed
• care
• contracting

and

• relationships
• through
• direct
• input
• from
• affected
• departments, including
• registration,
• patient
• accounting,
• billing,
• utilization
• management,
• medical
• records,

and

• quality
• improvement.
• 4.

Participates

in

• improving
• service
• by
• serving

on

committees

or

• task
• forces,
• collecting
• data
• when
• appropriate,

and

• sharing
• ideas

for

• improvement.
• 5.

Serves

on

Process

Improvement

Teams

• as
• requested.

Self-Development

1.

Attends

• at
• least
• one
• educational
• program
• each
• year (i.e. HFMA, Becker

’

s or applicable other as approved by Chief of Payor Contracting).

Regulatory

Compliance

1. Demonstrates

awareness

of,

and

compliance

with,

• patient
• safety and
• regulatory

and

• licensing
• standards;
• i.e.,

TJC,

Title

22,

OSHA,

HIPPA

and

Washington Hospital's

• numbered
• memorandums.