Director of Managed Care and Contracting - Cincinnati, United States - Communicare Health Services

Description

CommuniCare Health Services is a fast-growing provider of long- term care with over 130 facilities located in 7 states.

CommuniCare is dedicated to our goal of creating Caring Communities where staff, residents and families join hands to overcome their daily challenges.

The Corp.

Director of Managed Care & Contracting will oversee strategy and development for all Managed Care Services and Contracting for the LTC and New Vista lines of business.

The Corporate Director is responsible for full managed care contract life-cycle support, including new business and revenue development through continued clinical integration and market expansion.

Job duties & responsibilities

Develop, negotiate, and implement new and ongoing payor strategies, models, and partnerships that support CommuniCares low cost/high quality model, leverage synergies, and maximize profitability
Proactively identify and engage target payors who are candidates for innovative partnership models that address national needs, such as pay-for-performance, bundled payments, payments to support accountable care organizations, and various other alternative payment models
Lead contract development, rate methodologies and negotiation for complex deals and unique partnership models
Develop and foster strong payor relationships built on trust and collaboration, and manage payor expectations throughout the development and negotiation process
Understand and leverage strong knowledge of regional, state, and federal regulations, laws and legislative agendas regarding the healthcare industry that impact CommuniCare in order to improve partnership models
Leverage market intelligence, tools, financial modeling systems and resources to ensure that deal execution is informed by comprehensive and robust strategic analysis
Deliver improved payor satisfaction through the execution of strategic programs
Assist in the due diligence and integration of acquisitions
Lead and maintain credentialing, re-recredentialing, reimbursement, and contracted entities updates
Maintains patient confidentiality and functions within the guidelines of HIPAA.

Furthermore, person will work with the senior leadership team in the planning and execution of network development and acquisition and partnership strategies.

Develops key resources for the contracting department to aid in the improvement of revenue, operations, and other business functions.
Provides guidance and direction to cross-functional business team members including, Operations, Admissions, Billing and/or Finance.
Assist with claims escalation processes with payer partners

Effectively mentors, manages, and trains individuals, teams, and other staff members within the Managed Care Contracting Department and the Company.

Ensures timely and accurate setup and ongoing maintenance of contracts with contracted entities including, but not limited to payors, facilities, subcontractors, and other legal entities.

Leads and assists with RFPs.
Reports monthly on contract status to the Division and Home Office
Develops strategies for contracting priorities
Support and educate Case Management
Solves complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.

Serves as a subject matter expert on contract and reimbursement-related issues impacting our industry and healthcare industries, particularly with a managed care and commercial reimbursement focus.

Management/Supervision:

Responsible for ensuring an effective on-boarding, and providing comprehensive training and regular feedback for Executive Directors and other leadership roles on Managed Care.

Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards
Establishes annual goals and objectives for the department based on the organizations strategic goals
Responsible for achieving organizational performance and retention goals, including timely completion of performance evaluations

Knowledge/Skills/Abilities

The qualified candidate will have extensive knowledge and relevant work experience in the Managed Care/insurance sectors including network planning/development, contract negotiations, etc.

Must have presentation experience, excellent written and verbal communication skills, and ability to supervise and organize staff functions. Five (5) years of management experience in related position is preferred. Experience with Long Term Care contracting is a must.
Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies
Proficient computer skills and knowledge of Microsoft Office specifically Excel
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
This position reports to the VP of Revenue Cycle
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