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Director, Managed Health Resources

 

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Job Summary

 

Maintains Carolinas Healthcare System (CHS) 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 CHS 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 CHS Contracting Plan and individual negotiation plans.
  • Develops and maintains relationships with contracted Payors.
  • Maintains current working knowledge of all CHS 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 CHS managed care initiatives and results to appropriate audiences. Serve as MHR lead for Carolinas Physicians Services (CPN) 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 and 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. Three to five years’ experience in managed care, including contract negotiation, financial, operation analysis and legal review preferred.

 

Consultant:

For additional information and/or confidential consideration, please contact Tricia French RN, BSN at tfrench@frenchgroup.com

 

The French Group, Healthcare Executive Search

477 Viking Drive, Suite 230

Virginia Beach, VA 23452

(757)362-0202