Director, Ancillary - California, United States - Regal Medical Group

Description

Director, Ancillary & Contracting

#UHM-2989
Area of Interest
Provider Network
Position Type
Full-time
Job Description

Position Summary:

The Director, Network Management Ancillary and Institutional Contracting is responsible for working in collaboration with the Chief Financial Officer, Vice President of Regional Operations and Vice President of Hospital Contracting to identify, develop and oversee opportunities for development and growth throughout all networks and service lines.

Coordinates or performs projects/activities as delegated by Chief Financial Officer, Vice President of Regional Operations or Vice President of Hospital Contracting.

The Director of Network Management, Ancillary and Institutional Contracting, is responsible for assessing network needs, monitoring operational and fiscal performance and contractual compliance by network; along with coordination of recruitment/ provider negotiation needs with Medical Management, Network Operations, Hospital Contracting and Provider Relations.

Essential Duties and Responsibilities include the following:

In collaboration with the Chief Financial Officer, Vice President of Regional Operations or Vice President of Hospital Contracting, identifies opportunities for the development and growth of Ancillary and Institutional Provider Networks; including but not limited to Hospital Contracting, Ambulatory Surgical Centers, Ambulance and Transportation Services, Dialysis Centers, Durable Medical Equipment, Home Health and Hospice Services, Imaging Centers, Laboratory and Pathology Providers, Physical Therapy, Occupational and Speech Therapy Services and Hospital-based Physician Groups.

Identifies network needs and communicates deficiencies and/or new areas of growth to Chief Financial Officer, Vice President of Regional Operations, Medical Director(s) or Vice President of Hospital Contracting
Coordinates recruitment and negotiation activities of Network Management staff assisting with Ancillary and Institutional contracting in assigned networks.
Coordinates negotiation of Letters of Agreement for out-of-network providers as requested by Medical Management or Network Management.
Assesses network performance and recommends changes to network based upon financial or statistical results.
Daily interaction with Medical Management and Network Management operational functions.
Coordinates site audits for credentialing and Provider training purposes.
Resolve Provider grievances and appeals in accordance with contractual requirements and corporate policy.
Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.
Internal contract liaison for Claims, Customer Service and Utilization Management Departments.
Develop and implement regional policies and procedures
Facilitate quarterly Joint Operations Meetings with contracted Hospitals and Ancillary Providers as needed or requested.
Conduct ongoing staff development activities that advance negotiation skills, provider relations and network development processes.
Assure compliance with the Employee Handbook policies and procedures.
Conduct staff meetings on at least a monthly basis.
Maintain patient confidentiality so that HIPPAA compliance is observed at all times.
Ongoing monitoring of staff assignments to assure timely completion.
Assist with special projects as assigned.
The pay range for this position at commencement of employment is expected to be between

$125, ,000 annually

; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.

Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:
The success of any company depends on its employees.

For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.

As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero co-payments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services

Savings and Retirement:
401k Retirement Savings Plan
Income Protection Insurance

Other Benefits:
Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Business-casual working environment
Sick days
Paid holidays
Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Education and / or Experience:
Must have at least 4-6 years supervisory experience in Contracting, Provider Relations or Physician Recruitment; more experience preferred
Ability to work with all levels of management
Advanced knowledge of contracting principles/tools and various managed care reimbursement methodologies
Must have excellent verbal and written communication skills.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Must be able to travel within service area and have valid driver's license and insurance

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