Director Managed Care Contracting

Department:

10702 Advocate Aurora Health Corporate - Managed Care: Operations

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Full time 8-5; Fully Remote

MAJOR RESPONSIBILTIES

• Develop, evaluate, negotiate, implement, and communicate all aspects of a managed care or value added service contract, including but not limited to financial terms, operational responsibilities, delegation issues, utilization management, quality assurance program and credentialing process.
• Manage and assure integration and development of system strategies and contracting opportunities that may include shared savings, global/partial risk, fee-for-service and Accountable Care Organization.
• Identify opportunities for enhancing system wide understanding and support of the contracting process.
• Provide consultative support to Advocate senior management, Boards and various subcommittees.
• Serve as a key resource and develop contracting parameters (i.e. pricing, operations contract language, plan design) with Boards and subcommittees, PHO and medical group Directors, and Managed Care Contracting Committees.
• Serve as principal relationship manager, monitoring, maintaining and continually improving the relationships among managed care payers, sites, PHOs, product lines, medical groups, and vendors of value-added services.
• Develop contracting parameters with Boards and contracting committees, such as the Consolidated Finance Committee (CFC), and Operating Unit Managed Care Contracting Committee (OUM3C). Develop and present summary of contract provisions to these committees, and provide summaries as needed to the designated site directors for presentation to the facilities' designated senior level management team.
• Assure correct loading of contracted provider network contract terms and facilitate implementation of HMO, PPO, POS, and other contracts with all departments, including finance, claims, customer service, medical management, and operations; and hospital patient accounts, admitting, registration, outpatient department and inpatient utilization management.
• Work with the contracted managed care payers to execute quality, revenue cycle targets, utilization, case management, credentialing programs and satisfaction surveys.
• Assure compliance with the Federal, State, HMO regulatory agencies, NCQA and/or similar accreditation requirements.
• Work with other Advocate Aurora departments to develop and implement system-wide programs related to managed care.
• Participate in the development of protocols, guidelines and special programs in order to improve interaction between and among Advocate and external entities. These may include initiatives to streamline administrative procedures, enhance revenue cycle operations, and improve physician support, among others.
• Conduct regular managed care seminars and/or in-services for medical staff and Advocate associates.
• Act as a resource for managed care questions and staff training for physicians and Advocate associates.
• Maintain communication with and provide assistance to operations, physicians, hospital departments, and contracted providers regarding medical and administrative procedures and processes.
• Act as a primary managed care liaison to system product line assignments. Involvement in product development, managed care strategy.
• Act as a liaison to the Corporate Sales Staff for coordination of efforts as to managed care payers and contracting activities.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Recommends operating budgets, service area global financial risk budgets, and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations, and laws applicable to the organization's business.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

License/Registration/Certification Required: None

Education Required: Bachelor's degree in financing or related field.

Experience Required: 7 years in marketing/operations/finance involved in managed care contracting.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

• Excellent contract negotiation skills.
• Thorough knowledge of hospital and physician (multi- specialty group, IPA or PHO) operations and services impacted by managed care. Thorough knowledge of the managed care industry.
• Knowledge of various reimbursement methodologies for both physicians and hospitals.
• Ability to develop computer financial models and pro-forma statements to determine viability of PHO compensation, payer rates, and value-added service vendor costs.
• Excellent written and verbal communication skills.
• Ability to navigate through clinical decision support system.
• Ability to use spreadsheet, presentation, and word processing software effectively.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Pay Range
$66.85 - $100.30

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.