Director - Managed Care MHS

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Location:

Hollywood, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

Corporate-level leader responsible for executing enterprise-wide strategic and tactical initiatives for complex negotiations with major national and regional payors.

Manages execution of contracting initiatives for integrated delivery system and clinically integrated network to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers.

Responsible for securing negotiations of all contractual provisions, evaluating and implementing appropriate financial reimbursement models and supporting operations by collaborating with clinical and administrative leadership to enhance revenue and address payer imposed challenges. Implements strategic and tactical initiatives to achieve organization and department goals.

Responsibilities

Enhance, estimate and preserve net revenues. Assures financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution. Execute strategies and guides operations to protect and build market share.

Plan and monitor activities of staff and/or team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching & disciplinary actions, as applicable.

Execute and manage complex legal, financial and operational contract language negotiations. Execute contracting strategy for all service lines in Memorial hospitals, Atlantic Coast Health Network (clinically integrated network), Memorial Health Network (clinically integrated network), MHS employed physicians, transplant programs (including subcontracting hospital-based groups), and ancillary services (ambulatory surgical centers, skilled nursing facility, rehabilitation facility, home health, home infusion, urgent care centers, sleep labs and other components) of the fully integrated healthcare delivery system, and its jointly-owned or joint-ventured entities for fee-for-service and value based agreements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements).

Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with major national and regional payors.

Monitor department operations, activities, resources to meet budget and goals.

Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands, and legislative considerations and changes to the managed care industry to maintain a competitive position.

Initiate and research new business opportunities (relationships, pricing, services, structures, operations, quality).Escalate, monitor and manage operational issues from Managed Care Revenue Optimization, Accounts Receivable Management or Joint Operations for solution or potential litigation. Advise and support optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations polices for authorization, denials, discharge planning, pharmaceutical programs, etc. Communicate, coordinate and research to collect information to resolve issues.

Competencies

Education and Certification Requirements:

Bachelors (Required)

Additional Job Information

Complexity of Work:
Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Strong technical, financial and negotiation skills. Extensive managed care insurance and hospital industry knowledge. Required

Work…