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Position Details

Department: CORP | Managed Care Admin
Category: Director/Management
Location: Phoenix
Posting #: 602561
Date Posted: 6/21/2021
Employee Type: Regular

Position Summary

Posting Note: The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third-party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PCH, PCMG and PCCN contractual relationships.

The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PCH, PCMG and PCCN contractual relationships.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. Directs all contracting activities for the enterprise-wide payor contract portfolio.
    • Directs contracting staff activities to achieve optimal contract financial and operational outcomes as well as effective contract management. Responsible for contract negotiations, including rates, payment methodologies, contract language and value based payment programs in accordance with internal control processes for contract review, approval and signature. Ensures contracts are negotiated within established parameters and acceptable time frames for maximum performance. Makes recommendations for contract strategies.
  2. Oversees the activities of the Provider Enrollment staff.
    • Oversees the activities of the Provider Enrollment team to ensure timely and accurate enrollment of facilities and employed providers with contracted payers. Ensure compliance with credentialing, recredentialing and delegated credentialing requirements related to Provider Enrollment. Monitor and update provider demographic information.
  3. Educates network providers and staff on key managed care principles, market trends, and opportunities for improvement in support of enterprise goals and objectives
    • Prepares and provides training on pertinent subject matter to network providers. Proactively communicates and educates operational areas on contract changes, policy updates, etc. To ensure staff have information needed to successfully implement and operationalize agreements. Participates in or conducts presentations as needed.
  4. Coordinates and leads activities using a collaborative and team approach.
    • Demonstrates attention to detail, strong interpersonal skills, and project management skills to effectively conduct team meetings, engage team members, secure cooperation, and accomplish department goals and objectives. Handles multiple projects and ensures teams perform as needed under tight deadlines with a focus on effective implementation, communication and follow-up. Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group`s achievement of goals and to help foster a positive work environment.
  5. Plays a key role in managing relationships for network hospitals, physicians, ancillary providers and vendors related to managed care agreements.
    • Ensures contracting, payor relations and provider services staff develop positive, effective relationships with internal and external customers. Provides direction needed by staff to interface effectively with internal staff, providers, payors, and health plans in negotiations, problem resolution and dispute management.
  6. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelor`s degree in finance, health administration, or related field; OR five (5) years of managed care supervisory experience. Required
2. Master`s degree Preferred
Do you meet this requirement?
Experience
1. Ten (10) years managed care experience. Required
2. Five (5) years supervisory experience. Required
3. Three (3) years comprehensive managed care contracting for an integrated delivery system, ACO, multi-hospital system, or health plan. Required
4. Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared savings and risk contracting, managed care regulations, quality metrics and risk contracting. Required
5. Experience and/or familiarity with facility and professional billing systems and processes. Knowledge of CPT, HCPCS, facility revenue codes, and diagnosis codes. Required
Do you meet this requirement?
Certifications/Licenses/Registries
1. Health Care Financial Management Association (HFMA) certification. Preferred
Do you meet this requirement?
Special Skills
1. In depth knowledge of managed care concepts, including finance, information systems, billing and claim adjudication, regulatory environment, and provider community. Required
2. Excellent skills with Microsoft Office, especially Word, Excel, Outlook and PowerPoint. Required
3. Strong verbal and written communication skills. Articulate and able to speak with credibility to small or large groups. Required
4. Strong project management experience. Preferred
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Occasionally
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Frequently
8. Physical Requirement - Standing Occasionally
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Frequently
11. Physical Requirement - Walking Frequently
12. Physical Requirement - Near Vision Frequently
13. Physical Requirement - Far Vision Occasionally
14. Physical Requirement - Color Discrimination Occasionally
15. Physical Requirement - Use of keyboard, mouse and/or computer equipment Frequently
16. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
17. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
18. Occupational Exposure/Risk Potential - Inside office environment Applicable
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply