Director of Managed Care Contracting

ID157034
Full Time Regular
4714 Gettysburg Road
Mechanicsburg, PA 17055
|
View Maps & Directions

Job Description

Responsible for planning, analysis, negotiation, and implementation for new and renegotiated contracts for assigned hospital portfolio.  Serve as corporate liaison for Operation and Business Development leaders as well as key corporate functional support areas.   This position will focus on increasing net revenue through favorable contracts that exceed our costs to provide care as well as on capturing maximum referral volume from each executed contract and increasing out of network volume wherever feasible.  Serve as contracting leader for new hospital integration and consolidations/closures.

Responsibilities

  • Analyze, negotiate, and implement new and renegotiated contracts for assigned clinic portfolio: Develop payor strategies to ensure optimal contracting and operational performance for assigned markets. Manage implementation of new contracts and renegotiations and be responsible for payment methodologies, contract language, following all internal controls for contract review, approval, and signature. Ensure COLA’s and charge master changes are processed on time. Negotiate and administer single case agreements.
  • Corporate Liaison for Operations and key support functions: Implement new contract rollouts and post rollout analysis, work closely with designated Director of Finance regarding changes (positive and negative) impacting reimbursement, discuss strategies to enhance reimbursement rates and contract performance, partner with Legal on an as needed basis for contract related questions or issues, and assist Billing team with contract related questions or issues. Coordinate information and analysis requests from case management
  • Hospital and Payor Relations: Promote use of Contract Information Systems and other tools, develop and maintain positive payor relations, identify and address issues and respond to inquiries/issues for new and renegotiated contracts. Review insurance verifications as needed to ensure accurate capture for contract activities.
  • Ensure Hospitals maximize utilization of contracts: Participate in new employee orientation of hospital leaders/support staff, obtain payor contacts for new contracts to establish initial and ongoing meetings, and chair quarterly trend report calls and disseminate market trend findings/opportunity and track post meeting action items and status.
  • Business Development and Integration: Oversee contract implementation for new clinic openings/mergers, JV’s, and Acquisitions and work closely with Credentialing to assure payor credentialing requirements have been met.

 

Qualifications

  • Bachelor’s degree required, Masters preferred.
  • 3-5 years demonstrated experience in a managed care setting,  preferably working in contracting or provider relations for a Provider with a large network of hospitals.

Additional Data

Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.

AF123

Apply

Apply Now

Apply from a Different Device

To complete your application on another device, simply send it to yourself here. We do not store this email or use it for any purpose other than forwarding this job to the name and email that you designate.

Not Ready to Apply? Join Our Talent Network

If you are interested in our Career opportunities but not ready to apply, join our Talent Network to stay connected to us and receive updates on the latest job opportunities and company now.

Join Our Talent Network
Questions? We can help!
Contact Us