We are recruiting for a Director, Managed Care Relationships to join our Managed Care Department in Louisville, KY.
An experienced Managed Care executive to lead development and execution of the Managed Care strategy, including all managed care related contracting and payor relations initiatives for assigned markets, including the Chicago Market. This individual will serve as a key market leader and critical liaison between the market's managed care payers and Kindred Hospital Division operations and other support services (Case Management, Sales and Marketing, Business Office, etc.). Collaborates with market colleagues to identify and execute on business development and revenue growth opportunities with third party payors, systematic clinical or operational issues with managed care payors, revenue enhancement opportunities through improved Managed Care contracting, as necessary. This position is both internal and external facing, develops and maintains effective working relationships with key stakeholders with managed care payers in the market. Executes on business development opportunities by focusing on Kindred's value proposition and drives increased managed care penetration across the Kindred's continuum of care.
Essential Functions (as applicable based on market and number of direct reports):
Develops and updates the local Market Managed Care Strategy, * in collaboration with Operations leadership, the VP, Managed Care and other market colleagues, including documentation of goals, activities, and progress achieved
In collaboration with the regional VP, Managed Care, determines the optimal allocation of necessary resources to effectively manage the relationships with payers in the market, including provider organizations under a contractual or risk-bearing agreement
Builds and maintains managed care payer relationships in support of the Managed Care strategy for each market to ensure (i) appropriate contact and communication at all necessary levels within the payor organization (e.g. contracting, medical management, discharge planning, etc.), (ii) communication of the continuum of care value proposition (iii) resolving ‘barriers to entry’, and (iv)consistency of messaging in general
Owns and manages all aspects of assigned portfolio of managed care contracts and associated payer relationships, including (i) identifying opportunities to grow our Managed Care business and scheduling meetings with the relevant payer contacts, (ii) creating tailored presentations / materials, (iii) seeking preparation and attendance support from appropriate internal colleagues, as necessary, and (iv) leading payor meetings
Sponsors and holds quarterly Joint Operating/Quality Committee (JOC/JQC) meetings with managed care payer leadership and key decision-makers to identify and pursue business growth opportunities, resolve key clinical and/or operational issues, etc.
Sponsors quarterly cross-divisional, cross-functional Managed Care Meetings (a forum for communication between the market's key internal constituents) to assess key managed care trends, inform and adjust market-based managed care strategies and contract initiatives, as necessary
Educates and trains core group of market operators and other internal support services (e.g. Business Office, Admission, Sales & Marketing, Medical Management, etc.) on relevant elements of new or renegotiated contracts
Updates payer-specific activity for assigned accounts including contract development and implementation.
Documents critical reporting capabilities for Kindred based on payers' evolving data needs, as identified in JOC and other meetings
Manages local and attends national conferences, as relevant
Attends relevant regional, division and district staff meetings
Direct Contract Responsibilities:
Works collaboratively with key internal constituents (e.g. Operations leadership, CFOs, other managed care team members, etc.) to establish optimal Managed Care pricing
Leads the financial analysis of various pricing methodologies and scenarios
Directly negotiates contracts with acceptable managed care payors than enable assigned markets to meet their performance objectives
Maintain integrity of managed care information, including Managed Care Databases, contract rate dissemination and education in concert with Sr Dir Managed Care
Monitors and keeps current on Federal/State laws and regulations as they apply to health benefit contracts
Tracks and monitors all contract activity for assigned market area
Builds consensus with Market Executive Directors/CFO and Sr Dir Managed Care on Managed Care goals, objectives, strategies, individual contract terms, etc.
Prepares financial impact analysis/ modeling on new and revised contracts and maintains oversight tracking and yield determination
Works collaboratively with Sr Dir Managed Care to ensure compliance & successful implementation
Self-motivated and results oriented
Strong organizational and interpersonal skills, including the ability to work collaboratively in a matrix environment and with various colleagues at all levels of the organization to achieve defined market-specific goals
Ability to apply knowledge of clinical coding/terminology and various reimbursement methodologies, including regulatory requirements to acceptable managed care contract terms
Comprehensive understanding of industry standard managed contract language and the impact on various aspects of our business
Ability to effectively communicate in English in verbal, written, and presentation form
Demonstrated analytical abilities and proficient planning skills and negotiation skills
Ability to work under stress and meet deadlines
Ability to travel occasionally ; approximate percent of time required to travel: 30%
Bachelor's degree in business or related field. Master's degree preferred.
10 years healthcare experience in the areas of managed care contracting and/or business development. Knowledge of the Post-Acute industry preferred.
Depending on a candidate's qualifications, this position may be filled at a different level.
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Job : Insurance/Worker's Comp/Mgd.Care Primary Location : IL-Chicago-Kindred Hosp - Chicago Central Organization : 4667 - Kindred Hosp - Chicago Central Shift : Day