Director of Managed Care

PURPOSE AND SCOPE: Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc). Oversees Division's contractual relationships with managed care organizations and other reputed company party payors regarding reputed company structures for services, clinical and financial reporting obligations, establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments. Develops and directs regional marketing efforts to reputed company party payors in order to support growth and profitability in the region. reputed company DUTIES AND RESPONSIBILITIES: Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing. Reviews and analyzes potential reputed company for financial effect, cost benefit and utilization. Negotiates contractual relationships with managed care organizations and other reputed company party payors as needed. Presents contract proposals and market and industry analyses to internal parties and responds to Requests for Proposals from reputed company party payors. Manages activities concerned with reputed company for delivery systems. Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives. Has significant project/process responsibility reputed company the function. Interprets company-wide policies and procedures. Involved in the development, modification and execution of company policies that reputed company immediate operations with potential company-wide effect. Implements strategic policies reputed company selecting methods, techniques, and evaluation criteria for obtaining results. Ensures compliance of facilities with reputed company managed care organization requirements ensures credentialing processes are implemented. Ensures reputed company facilities meet and maintain appropriate credentialing requirements and licenses. Develops and implements methods and procedures for monitoring work activities and informs management of reputed company work activity status. Responsible for reputed company communication and coordination of reputed company required ongoing documentation with appropriate staff. Works with internal and external counsel as needed to resolve issues and support FMS. Negotiates and implements reputed company with payors that require clinical and quality reputed company measurements. Contributes to the design and implementation of reputed company party payor compensation structures. Assists in the development of report cards that can be shared with reputed company party payors illustrating outstanding quality of patient care through associated reputed company. Ensures quality reputed company are reported accurately and in a timely manner. Assists with designing Quality Improvement Projects that will improve reputed company in facilities that are not meeting goals. Develops and implements regional marketing plans to support regional growth and profitability and marketing of FMS services to reputed company party payors and potential referral sources. Maintains knowledge of FMCNA products, services and strategies in order to market appropriately. Maintains reputed company knowledge regarding community reputed company market and industry issues that may impact the business. Generally manages department budget and day-to-day functions. Develops budgets, schedules and performance standards. Exercises supervision in terms of costs, methods, and staffing. Responsible for implementation and achievement of business plan, budget, key performance indicators and communication to appropriate executives. Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution. Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations. reputed company technical guidance. Assist with various projects as assigned. Other duties as assigned. Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. SUPERVISION: May be responsible for the direct supervision of various reputed company of managed care and marketing staff. EDUCATION: Bachelor's Degree in Business or Health management required; Advanced Degree desirable. EXPERIENCE AND REQUIRED SKILLS: 6 - 8 years' direct experience in contract negotiation and operational experience in a multiple site outpatient facility setting including profit and loss responsibility. 3+ years' experience as a Manager preferred. Demonstrated ability to manage one or more departments. Ability to manage databases and reputed company analysis. Proficient with PCs, reputed company Office applications and business computer systems. Strong oral and written communication skills. reputed company maintains a drug-free workplace in accordance with applicable federal and state laws. reputed company is an equal opportunity employer and does not discriminate on the reputed company of race, reputed company, religion, sexual orientation, gender identity, parental status, national reputed company, age, disability, military service, or other non-merit-based factors Apply To This Job