Director of Managed Care - #256697

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

• Bachelor’s degree in healthcare, business or finance or equivalent experience required.
  
  

Experience / Qualifications

• Healthcare background preferred, proficient knowledge of governmental guidelines, managed care, and Medicare and Medicare Replacement plans.
• 5 years’ experience in contracting and working with 3rd party payers and/or managed care organizations required.
• Ability to work autonomously, excellent interpersonal and communication skills.
• Strong organizational skills.
• Ability to maintain confidential and company proprietary information.
• Ability to relate professionally and positively with employees at many levels.
• Strong analytical skills.
• Intimate knowledge of hospital and managed care finance.
• Strong written and verbal communication skills and experience with formal presentations.
• Superior problem solving, decision-making and negotiating skills.
• Team player with proven ability to develop strong working relationships within a complex organization.
  
  

Position Summary

Director of Managed Care is part of the team that is responsible for negotiating payer agreements. The Director participates in the development, negotiation, implementation, monitoring and management of all third-party payor contracts. Director will develop and maintain a network of relationships with third party payors, establish and maintain effective relationships with system operational management, as well as Patient Financial Services.

• Develop the strategy, objectives, techniques, and tactics to achieve the strategic goals of the Organization.
• Collect, organize, and timely submit all credentialing requests.
• Understand reimbursement structures for VA, Medicare, Medicaid, HMO, and fee-for-service Health Plans and Provider Contracts.
• Manages contracting for hospitals, physician, and ancillary providers.
• Exhibit an ability to understand and negotiate add-ons, carve outs and exclusions to new and existing contracts, to ensure the most optimal payment agreement is in place.
• Assist in auditing of payments collaboratively with other departments to address and resolve operational issues as it relates to negotiated contract language.
• Prepare, analyze, review, and project financial impact of provider contracts and alternate contract terms.
• Negotiate contracts, and effectively manage the negotiation process.
• Develop and monitor managed care and payor metrics for contract performance, payor performance, and organizational performance.
• Responds to provider inquiries / concerns / complaints and assist in resolving elevated and complex provider service issue.
• Develop financial and market analysis in preparation for negotiations.
• Draft, review and negotiate all Payer contracts, including ones flexible enough to respond to an ever-changing market over multi-year agreements.
• Develop contract implementation tools and lead installation meetings to support the smooth operation and administration of contracts.
• Manage large appeals and negotiate settlements.
• Develop the strategy to incorporate the delivery and reimbursement for new technologies into existing and future contracts.
• Recognize revenue opportunities and develop a strategy to incorporate them into existing and future contracts.
• Effectively uses and role models current management techniques and theories, encouraging the decision-making skills of staff members and providing insight and leadership in complex situations.
• Supervises the development of service policies, procedures, and operating guidelines. Collaborates with other services within the division. Ensures that information is disseminated to staff is monitored for effectiveness and changed as needed.
• Understands and enforces all hospital and personnel policies and procedures.
• Lead and/or serve on hospital and Patient Care Services committees, teams, and work groups as required.
• Performs other duties as assigned
  
  

Leadership Competencies

Establishing Relationships

Builds effective networks, working relationships, and alliances with a broad range of stakeholders (both internal and external) in order to collaborate effectively within divisions and across boundaries. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.

Developing Talent

Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively.

Inspiring and Motivating Others

Fosters commitment and cohesiveness by motivating, guiding, and facilitating cooperation within the department toward goal accomplishments. Can persuade others, build consensus, and ensure cooperation from others to gain genuine acceptance to accomplish “win-win” solutions.

Demonstrating Emotional Intelligence

Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.

Acting with Integrity

Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.

Acting Strategically

Aligns day to day activities around broader organizational goals and objectives; prioritizes resources based on the strategic objectives of the organization.

Being a Champion for Change and Innovation

Supports people in their efforts to try new things. Generates novel and valuable ideas and uses these ideas to suggest new or improved processes.

Communicating Effectively

Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and across the organization.

Promoting Diversity and Inclusion

Treats all people with dignity and respect by being fair and consistent. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenge’s bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Holding Self and Others Accountable

Sets clear performance expectations and objectives for self and others; evaluates work performance and provides feedback when needed. Accepts responsibility and accountability.

Physical Requirements

Requires sitting for long periods of time, also stooping, bending, standing, and stretching. May require lifting up to 20 lbs. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push/pull up to 40lbs., carry and lift up to 20lbs.

Threshold Requirements

• These threshold requirements are required and completed yearly basis
• Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation
• TB/PPD Surveillance Program
• Maintenance of required professional licensing and/or certification(s).
  

This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associates with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position.