Director - Managed Health Resources

Job Summary

Maintains managed care portfolio performance. Ensures appropriate planning and execution of each negotiation, and manages contracting staff to ensure appropriate contract rates and language are negotiated within established deadlines with yields that meet or exceed budget. Ensures the System maintains payor pricing parity and develops contracting strategy for the System, and ensures implementation of strategy through contracting activities.

Essential Functions

• Reviews staff output including financial and operational evaluation, rates, and contract language for all managed care contracts. Mentors and develops staff skills and abilities.
• Participates actively in system-wide major payor negotiation and participates in other negotiations on an as-needed basis.
• Ensures appropriate contracting planning is completed and presented to MHR Management, including annual Contracting Plan and individual negotiation plans.
• Develops and maintains relationships with contracted Payors.
• Maintains current working knowledge of all System contracts. Evaluate, recommend and oversee implementation of an on-line contract document management system.
• Provides System with accurate and current managed care market intelligence by maintaining a working understanding of local, regional, and national trends. Conducts competitive market assessments, changes and impact of regulatory environment, changes and impact of payor initiatives and provide other information to support MHR reporting initiatives.
• Communicates actively in managed care initiatives and results to appropriate audiences. Serve as MHR lead for Physicians Services Contracting Committee.
• Develops and maintains cooperative internal working relationships to effectively evaluate and assess overall impact of contracting initiatives. Proactively work with MHR Contract Compliance to understand operational issues and the impact on contracting. Proactively work with MHR Performance Management to report and refine reporting of contract performance, analysis and modeling tools.

Physical Requirements
Performs most work under normal office conditions. Work may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to 25 pounds.

Education, Experience and Certifications

Bachelor's Degree required, Advanced degree, MBA or MHA preferred. Seven years provider experience as a contract negotiator required; willing to consider ten years combined provider and/or payor experience as a contract negotiator. Proven track record of closing negotiations on time and at or exceeding budget expectations. Must have closed negotiations for a major payor/major system required.#J-18808-Ljbffr