Director of Managed Care / Payor Contracting
Troy, MI Troy, MI Full-time Full-time From $120,000 a year From $120,000 a year The Director of Payor Contracting and Managed Care will be the primary person responsible for the organization's contract management with commercial, Medicare and Medicare Advantage payors, direct contracts with employers, value-based care contracts, and other contractual agreements with external parties.
The Director of Payor Contracting and Managed Care leads the overall system of managed care for the organization.
This consists of two primary components; traditional provider - payor, contracting and relationship management, and strategic risk-based population management arrangements.
This individual will team up with and assist our CEO in developing and executing on end-to-end managed care and contracting strategies with payors.
The Head of Managed Care is also responsible for maintaining up-to-date fee schedules in our RCM systems and engaging in ongoing review of the economics of current contracts.
Job Duties:
Develop an organizational process for ongoing recordkeeping and oversee the maintenance of a uniform and indexable database repository for all of the organization's contracts; Oversee the maintenance of the most current and historical fully executed versions of all payor contracts for different insurance plans (commercial, Medicare, MA etc.
) Oversee the maintenance of a schedule of contract sunset dates, overseeing renewal planning, and scheduling all matters regarding renewal of contracts; Collaborate with RCM staff to maintain accurate contracted rates and ensure RCM staff properly and accurately enter information into internal systems; Evaluates, negotiates, and secures financially (and administratively) favorable managed-care contracts with new and existing health plans or managed care, organizations, as well as with national payors to ensure financial viability of contractual arrangements and the achievement of organizational goals; Partner with CEO and financial leaders to expand the number and type of managed care contracts; Partner with CEO and VP of Finance to conduct economic analysis on patient populations that are currently out-of-network; Develop strategy for negotiations of rate increases on existing contracts; Assist CEO in preparation of value-proposition materials in advance of payor negotiations and in conducting the actual contract negotiations; Collaborate with Analytics and Finance staff to prepare clinical, financial, and outcomes-based data for contract negotiations.
This includes identifying and implementing contracting opportunities for revenue improvement and administrative efficiency, while ensuring that contract renewals are modeled for financial impact; Assist leadership and liaise with counsel regarding papering of additional, new, or renewed contracts; Work with and assist the CEO in developing new relationships with payors, direct employers and value-based care entities; Engage with financial planning and analysis team to create real-time dashboards and tracking systems for review and analysis of contract performance; Develop models and necessary metrics for tracking and evaluating performance of value-based care contracts.
Basic Requirements:
Strong communication, strategic planning, interpersonal, lateral thinking, and critical analysis skills; Experience with communicating highly-technical material effectively; Bachelor's degree or significant experience in Healthcare Administration, Business, Finance, Law, or related field required; Masters degree preferred Strong knowledgebase in private-practice healthcare services; particular experience in musculoskeletal care, cardiovascular or adjacent specialties would be a plus; A demonstrated history of successful negotiation between private practices and major payor organizations; Significant understanding and working knowledge of managed-care organizations, their philosophies, motivations, and decision-making processes; Minimum of 10 years of managed care and payor contracts management experience; Strong organizational, inter-personal and communication skills; Experience in medical practice analytics and financial assessments; Prior experience working with practice management software.
Preferred
Qualifications:
Experience with medical automobile reimbursements and fee frameworks; Experience with building de novo payor relationships in the State of Michigan Experience with value-based care contracts; Significant experience with medical economics and reimbursement analytics.
Compensation Details:
Market-competitive annual salary commensurate with experience and performance-based bonus linked to value creation for the organization.
Physical Demands:
This position involves spending most its working time sitting.
There is a significant amount of data entry, reading, and writing, communication, and computer and telecommunication usage.
Applicants will need to be able to:
Spend at least six (6) hours per day sitting in a task chair at desk Communicate effectively in-person, electronically, and telephonically with patients, coworkers, and others Lift approximately twenty pounds (20 lbs.
); lift approximately ten pounds (10 lbs.
) over head Spend extended periods of time on sitting, looking at computer screen, monitoring data and electronic systems information.
Infrequent bending, reaching, squatting, sitting, pushing, and pulling.
Job Type:
Full-time Pay:
From $120,000.
00 per year
Benefits:
401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible schedule Health insurance Health savings account Life insurance Paid time off Professional development assistance Referral program Retirement plan Vision insurance Schedule:
8 hour shift Monday to Friday Supplemental pay types:
Bonus opportunities Ability to commute/relocate:
Troy, MI 48083:
Reliably commute or planning to relocate before starting work (Required) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
The Director of Payor Contracting and Managed Care leads the overall system of managed care for the organization.
This consists of two primary components; traditional provider - payor, contracting and relationship management, and strategic risk-based population management arrangements.
This individual will team up with and assist our CEO in developing and executing on end-to-end managed care and contracting strategies with payors.
The Head of Managed Care is also responsible for maintaining up-to-date fee schedules in our RCM systems and engaging in ongoing review of the economics of current contracts.
Job Duties:
Develop an organizational process for ongoing recordkeeping and oversee the maintenance of a uniform and indexable database repository for all of the organization's contracts; Oversee the maintenance of the most current and historical fully executed versions of all payor contracts for different insurance plans (commercial, Medicare, MA etc.
) Oversee the maintenance of a schedule of contract sunset dates, overseeing renewal planning, and scheduling all matters regarding renewal of contracts; Collaborate with RCM staff to maintain accurate contracted rates and ensure RCM staff properly and accurately enter information into internal systems; Evaluates, negotiates, and secures financially (and administratively) favorable managed-care contracts with new and existing health plans or managed care, organizations, as well as with national payors to ensure financial viability of contractual arrangements and the achievement of organizational goals; Partner with CEO and financial leaders to expand the number and type of managed care contracts; Partner with CEO and VP of Finance to conduct economic analysis on patient populations that are currently out-of-network; Develop strategy for negotiations of rate increases on existing contracts; Assist CEO in preparation of value-proposition materials in advance of payor negotiations and in conducting the actual contract negotiations; Collaborate with Analytics and Finance staff to prepare clinical, financial, and outcomes-based data for contract negotiations.
This includes identifying and implementing contracting opportunities for revenue improvement and administrative efficiency, while ensuring that contract renewals are modeled for financial impact; Assist leadership and liaise with counsel regarding papering of additional, new, or renewed contracts; Work with and assist the CEO in developing new relationships with payors, direct employers and value-based care entities; Engage with financial planning and analysis team to create real-time dashboards and tracking systems for review and analysis of contract performance; Develop models and necessary metrics for tracking and evaluating performance of value-based care contracts.
Basic Requirements:
Strong communication, strategic planning, interpersonal, lateral thinking, and critical analysis skills; Experience with communicating highly-technical material effectively; Bachelor's degree or significant experience in Healthcare Administration, Business, Finance, Law, or related field required; Masters degree preferred Strong knowledgebase in private-practice healthcare services; particular experience in musculoskeletal care, cardiovascular or adjacent specialties would be a plus; A demonstrated history of successful negotiation between private practices and major payor organizations; Significant understanding and working knowledge of managed-care organizations, their philosophies, motivations, and decision-making processes; Minimum of 10 years of managed care and payor contracts management experience; Strong organizational, inter-personal and communication skills; Experience in medical practice analytics and financial assessments; Prior experience working with practice management software.
Preferred
Qualifications:
Experience with medical automobile reimbursements and fee frameworks; Experience with building de novo payor relationships in the State of Michigan Experience with value-based care contracts; Significant experience with medical economics and reimbursement analytics.
Compensation Details:
Market-competitive annual salary commensurate with experience and performance-based bonus linked to value creation for the organization.
Physical Demands:
This position involves spending most its working time sitting.
There is a significant amount of data entry, reading, and writing, communication, and computer and telecommunication usage.
Applicants will need to be able to:
Spend at least six (6) hours per day sitting in a task chair at desk Communicate effectively in-person, electronically, and telephonically with patients, coworkers, and others Lift approximately twenty pounds (20 lbs.
); lift approximately ten pounds (10 lbs.
) over head Spend extended periods of time on sitting, looking at computer screen, monitoring data and electronic systems information.
Infrequent bending, reaching, squatting, sitting, pushing, and pulling.
Job Type:
Full-time Pay:
From $120,000.
00 per year
Benefits:
401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible schedule Health insurance Health savings account Life insurance Paid time off Professional development assistance Referral program Retirement plan Vision insurance Schedule:
8 hour shift Monday to Friday Supplemental pay types:
Bonus opportunities Ability to commute/relocate:
Troy, MI 48083:
Reliably commute or planning to relocate before starting work (Required) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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