Job Description

Centers Health Care is looking for a Director of Managed Care.

Responsibilities:

  • The Director of Managed Care will be responsible for developing, implementing, and coordinating of managed care contracting and related activities for Centers Health Care under the direction of the VP, Managed Care Contracting and Payer Strategy
  • Managing assigned portfolio of Centers Health Care payer contracts and relationships for all network Skilled Nursing facilities and ancillary lines of service
  • Developing payer strategies to ensure an optimal contracting and operational outcome for Centers Health Care, advocating on behalf of the Centers as issues, opportunities or disputes arise
  • Negotiating rates and terms including: pay-for-performance, and risk contracts with managed care payers on behalf of Centers, including rates, payment methodologies, contract language, value-based reimbursement and risk or bundled payment programs
  • Monitoring contract performance regarding financial performance, payment integrity, value-based payment programs, compliance with contract terms and key performance indicators
  • Monitoring payer activity with respect to network development, product strategies, payment policies and other relevant market intelligence
  • Liaison to assigned payers and operational areas within Centers, with a focus on promoting proactive, professional, and collaborative relationships, problem resolution and growth strategies where appropriate
  • Collaborate with Centers Health Care management, business development and support areas such as central billing offices and case management areas to improve functions across departments and with payers
  • Prepare and provide training, materials, and tools for use by Centers staff regarding key managed care contract provisions, market trends and opportunities for improvement in support of facility goals and objectives, consistent with the goals and objectives of Centers Health Care

Qualifications:

  • Minimum of five years’ (5) experience in Medicaid/Medicare, Managed Care is preferred
  • Knowledge of managed care regulations and payment methodologies
  • Ability to handle multiple projects and perform independently under tight deadlines
  • Experience growing key accounts by adding increase value within scope of responsibility
  • Demonstrates strong leadership skills
  • Excellent verbal, written and interpersonal communication skills

Application Instructions

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