Managed Care Contracts Senior Director Ambulatory

Job Summary

This position provides strategic planning, advice and counsel, develops policies and maintains operational relationships with managed care organizations. This includes provider relations activities, health management processes, language development, negotiations, communication/training, resource development and support of claims collections that affect the strategic, tactical, and financial viability of the organization and its joint venture partners.

Essential Functions

• Establishes organizational standards for contract language, communication processes of contract terms, managed care education resources, and contract management and administration. Negotiates contract language to support legal, operational, and financial objectives of the organization.

• Serves as team leader or key participant of regional operational groups that address activities related to managed care. These groups may include managed care organization claims and joint operating committees; hospital administrators and senior management managed care committees; the utilization management of the managed care operations group; organizational strategic initiative teams; change management committee.

• Serves as liaison between managed care organizations and organizational entities on a broad range of managed care operations issues by facilitating problem resolution and developing and maintaining relationships with senior management representatives of both organizations.

• Provides oversight and leadership for the maximization of the organizations financial performance by developing and implementing utilization and case management programs that interface with managed care organizations. This may include clinical program design within the contractual relationships with managed care organizations; overseeing implementation of the clinical program design by the organizations delivery system; problem resolution for operational issues that are both internal to the organization and external to managed care organizations; and preparation of managed care organization accreditation requirements.

Minimum Qualifications

Bachelors Degree in a relevant field or equivalent level of education and experience. Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five years of progressively responsible managerial experience, including a minimum of two years management level experience within a healthcare system setting or large multi-operational, complex corporate environment.

Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Drivers License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.

Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals. Must demonstrate skills and business acumen through direct leadership experiences such as: Anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.

Preferred Qualifications

Additional related education and/or experience preferred.