Community Health Systems Dir Managed Care in Florida
Under the direction of the VP of Managed Care, the Director, Managed Care will work closely under the guidance of Senior Steward leadership to negotiate reimbursement rates, legal terms, performance programs, and risk arrangements with managed care plans on behalf of Steward Health Care System, LLC (“SHCN ) (including Steward hospitals, physicians, and ancillary providers). The Director will develop recommended tactics and objectives for negotiations that maximize SHCN and providers financial performance as well as serve as a mentor to the Senior Contract Managers and act in the VP of Managed Care role if needed.
Other duties will consist of facilitating operational workgroups to gather input and define operational solutions to address health plan policies and procedures.
Sets direction, develops and prepares financial and risk analysis to support senior leadership.
Creates and communicates financial and risk terms with internal and external leadership including high-level hospital administrators and physician leaders.
Secure support for negotiation positions with both internal and external constitutes through strong and effective persuasive skills and technical knowledge
Designs models and performs ad hoc analysis for the purpose of understanding the historical and future performance of existing contracts.
Works closely with the Steward hospitals and physician groups to identify systemic issues (e.g., claims, underpayments, denials) and develops resolutions that can be addressed in the contract negotiations.
Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact managed care efforts (e.g., CMS, ACO regulations, Massachusetts Health Reform, etc.).
Provides support for the key Steward Health Care Network (SHCN) leadership meetings including: SHCN Board Meetings, the SHCN Finance Committee, and SHCN Negotiation Committee meetings.
Serve as expert on fiscal and legal provisions of the contracts.
Define and lead resolution process with providers and health plans to address system-level claims operations issues
Play a lead role in the development and maintenance of key legal terms
Education: Master s degree strongly preferred.
Experience (Type & Length): At least ten years as a leader in a managed care environment of a similar capacity including negotiating a wide range of performance based arrangements. Management / supervisor experience highly recommended
Critical and Analytical Skills: demonstrated leadership role in developing and assessing risk and FFS reimbursement models
Software/Hardware: Strong knowledge in Microsoft Office applications – Word, Excel, Access, and PowerPoint; proven ability to learn new information systems as necessary.
Other :Understanding of the health care delivery setting including both hospital and physician reimbursement and claims processing
Analytical skills to collect information from diverse sources and summarize the information and data in an order to solve problems.
Accuracy and attention to detail are required.
Strong interpersonal skills and ability to interact positively with a wide range of constituents.
Proven excellent written and verbal communication skills.
Ability to present information to small and, at times, large audiences of various skill levels.
Strong organizational and project management skills including development of project parameters, goals, and timelines as well as outcome measurement.
Must be able to maintain confidentiality of information.
Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary.
Ability to work both independently and within a team environment and a multi-dimensional environment.
Creative, flexible, self-motivated professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence.
Job: Case Management / Utilization Review
Requisition ID: 1742597