- 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 payers 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
- Bachelors Degree required
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Director Managed Care - Irving - CHRISTUS Health
Description
Description
Summary:
The Director 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 payers, 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.
Responsibilities:
Requirements:
Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time
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Registered Nurse Care Manager
Only for registered members Irving
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Nurse Manager – Critical Care
Only for registered members Irving, TX
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Registered Nurse Care Manager
Only for registered members Irving, TX
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Nurse Manager of Critical Care
Only for registered members Irving, TX
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Registered Nurse Care Manager
Full time Only for registered members Irving
-
Supervisor Care Management Population Health
Only for registered members Irving
-
Team Manager Care Support Training
Full time Only for registered members Irving
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Care Coordinator- Care Management
Only for registered members Dallas, TX
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Travel RN Care Manager - 1,182 per week
IDR Healthcare- Irving
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Registered Nurse Care Manager-Health Plan Admin
Only for registered members Irving, TX
-
Travel RN Care Manager - 1,182 per week
Freelance IDR Healthcare- Irving
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Team Manager Care Support Training
Only for registered members Irving, TX
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Care Coordinator- Care Management- PRN
Only for registered members Dallas, TX
-
Registered Nurse Care Manager-Health Plan Admin
Only for registered members Irving
-
Travel RN Care Manager - 1,182 per week
Only for registered members Irving
-
Care Manager
Only for registered members Dallas, TX
-
Care Manager
Only for registered members Dallas
-
Care Manager
Only for registered members Dallas
-
Care Manager
Freelance Only for registered members Dallas
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Care Manager
Only for registered members Dallas