Director, Managed Care

Job Description

Reporting to the AVP, Managed Care & Executive Director, PHO, the Director of Managed Care plays a crucial role that demands a unique set of skills to ensure seamless interactions with insurance payers, PHO physician members, hospital administrative leadership, and various other stakeholders. This highly visible position is primarily responsible for the administration of HSS PHO and the negotiation and implementation of HSS PHO managed care contracts, ensuring their alignment with HSS clinical initiatives and strategic priorities.

This includes engagement with various administrative and clinical stakeholders to determine contracting strategy to best support HSS PHO physicians.

• Meets with organizational leadership and stakeholders to ascertain and develop strategic payer contracting goals.
• Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
• Analyzes payer contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
• Works closely with the legal team to review and edit contracts as appropriate.
• Affirms contract administrative terms and payer policies to advise leadership accordingly on measures of contract performance.
• Maintains up to date knowledge on the healthcare market, specifically in regard to payer policies and reimbursement trends.
• Implements departmental policies, protocols and systems to enhance efficiency and effectiveness of workflows.

Experience, Competencies, And Personal Characteristics

• Experience (minimum 7+ years) with IPA/physician network administration and/or payer or provider contracting.
• Major teaching/surgical hospital experience or health plan experience is highly desirable.
• Experience managing and leading a professional team.
• Experience dealing with physicians and their office/billing staff.
• Possesses key payer contacts and knowledge of payer contracting and enrollment processes.
• Knowledge of the healthcare industry and payer reimbursement methodologies (both hospital and physician).
• The ability to work independently and collaboratively to solve complex problems.
• The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.
• Is professional when dealing with stakeholders; uses good judgement and takes a thoughtful approach to resolving and communicating issues.

Education

Bachelor’s degree in health or business administration, economics or related subject is required. Masters preferred.

Non-Discrimination Policy

Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.