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Job Requirements of Director Managed Care:
QUALIFICATIONS / EXPERIENCE:- Bachelor’s degree in Business with Masters preferred or equivalent experience
- 7 to 10+ years of experience managed care with 4+ year’s specific experience in Managed Care Contracting required, preferably carrier and provider background
- Experience with Managed Care Programs, the Managed Care market, and all reimbursement schemes that exist in the Managed Care industry including capitation, case rates and performance metrics
- Ability to work independently and exercise judgement in negotiating contracts or representing Team Health to clients
- Very well organized, ability to handle multiple practices
- Ability to carry out position responsibilities effectively
- Ability to prioritize and assign work to the Contracting Manager as necessary
- Excellent written and verbal communication skills
- Comprehension of legal contracts and contract language for multispecialty inpatient services on behalf of providers including, but not limited to, post-acute care services (skilled nursing and nursing facilities) and behavioral health
- Understanding and ability to practice negotiation techniques
- Ability to supervise others
- Post-Acute Care and Behavioral Health experience preferred
- Manages Contracting Manager
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Director Managed Care
TeamHealth
USA (Remote)
Full-Time
TeamHealth is proud to be the leading physician practice in the U.S. providing exceptional patient care, together. Newsweek Magazine recognizes TeamHealth ‘as one of the greatest workplaces for diversity and workplaces for women; 2024-2025’.Becker’s Hospital Review names TeamHealth among the top 150 places to work in healthcare. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us!
OVERVIEW:
The Managed Care Director has the overall responsibility to conduct negotiation and re-negotiation of Managed Care Plans on behalf of physicians practicing in multispecialty Post-Acute Care services and Behavioral Health for large volume state and regional/national contracts. The Director will provide project management coordination and management of TeamHealth’s internal review process for negotiating Managed Care Plans. The Director is also responsible for the supervision of the Contract Manager and support staff in their region. The Director is responsible for the training of new managers and specialist staff in their region.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Conducts negotiation and re-negotiation of Managed Care Contracts to include contract language and proposed reimbursements such as percentage of charges, case rate, capitation, value based agreements and other variations for high volume state and regional contracts
- Reviews in detail each proposed Managed Care Agreement and make recommendations for changes and modifications to conform to TeamHealth contracting guidelines with contract terms falling within the NCQA credentialing guidelines
- Acts as project manager over national contracting discussions with health plans that will involve medical leadership input on quality metric risks/incentives and will obtain internal approval prior to making specific commitments with health plans
- Stays current on industry trends and developments in the area of post-acute care services, including developments in the area of bundled payments, value based metric incentives, etc.
- Responsible for coordinating financial feasibility analysis and impact studies regarding the proposed contract rate and its impact on the revenue recognition, financial projections and operation budgeting processes for the Division
- Responsible for the supervision of the Contracting Manager, to assure the timely execution of contracts, to coordinate maintenance of spreadsheets, and to distribute information to contract management
- Leads the contract management department in managing the contract file for all Managed Care Plans including updates on pending expirations, proposed amendments and file maintenance
- Consults as needed with VP with unsolved problems
- Prepares reports as assigned by the VP completely, accurately, and within assigned time frames
- Participates as needed in the interpretation of contracts to assist Contract Management Department in the resolution of claim filing issues to assist in obtaining payments
- Handles other duties as assigned
Job Requirements:
QUALIFICATIONS / EXPERIENCE:
- Bachelor’s degree in Business with Masters preferred or equivalent experience
- 7 to 10+ years of experience managed care with 4+ year’s specific experience in Managed Care Contracting required, preferably carrier and provider background
- Experience with Managed Care Programs, the Managed Care market, and all reimbursement schemes that exist in the Managed Care industry including capitation, case rates and performance metrics
- Ability to work independently and exercise judgement in negotiating contracts or representing Team Health to clients
- Very well organized, ability to handle multiple practices
- Ability to carry out position responsibilities effectively
- Ability to prioritize and assign work to the Contracting Manager as necessary
- Excellent written and verbal communication skills
- Comprehension of legal contracts and contract language for multispecialty inpatient services on behalf of providers including, but not limited to, post-acute care services (skilled nursing and nursing facilities) and behavioral health
- Understanding and ability to practice negotiation techniques
- Ability to supervise others
- Post-Acute Care and Behavioral Health experience preferred
- Manages Contracting Manager
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