Director of Managed Care

Overview:

We are growing and in search of a Director of Managed Care to join our team!

Reporting to the Chief Financial Officer, this role will focus on achieving annual rate targets and managing all aspects of the payor contracting process. Responsibilities include, but are not limited to: contract management, system integrations, reporting, fee schedule accuracy, high-level rate analysis, credentialing support, education and training, monitoring payor and market changes, payor contracts due diligence for practice acquisitions, building relationships with Clinically Integrated Networks (CINs) and Accountable Care Organizations (ACOs), and leading contract negotiations.

The successful candidate will demonstrate self-motivation through results, build collaborative relationships, effectively inform and influence stakeholders, and exhibit sound judgment and integrity by addressing risks and opportunities in a timely manner.

Responsibilities:

Essential Duties and Responsibilities:

• Develop and execute annual contracting strategy, plan, and forecast to achieve company financial objectives. Lead negotiations with payors to secure and maintain competitive contracts with insurance companies, CINs, ACOs, and applicable government programs.
• Maximize network participation and balance payor mix opportunities across applicable lines of business (Commercial, Medicaid, Exchange, Medicare Advantage, etc.) to achieve rate goals.
• Maintain established documentation standards and continuously ensure all executed contracts, amendments, and current fee schedules are properly named, filed and/or archived.
• Routinely analyzes available data on rates, costs, utilization trends, write-offs, and administrative processes to assess performance as well as the cost of doing business with payors.
• Maintain an accurate Contract Tracker to manage and report on key contract terms, renewal dates, and contracting priorities.
• Cultivate and maintain proactive, productive relationships with key payors, CINs, and ACOs. Develop new relationships as required to meet business goals and strategic objectives.
• Collaborate with Revenue Cycle Management (RCM) to resolve payor issues as needed to optimize collections.
• Build collaborative and proactive relationships with physician leaders, practice administrators, and other internal stakeholders to ensure all applicable teams are informed of contractual changes.
• Support the due diligence and integration process for practice acquisitions, as required.
• Maintain effective written and verbal communication with internal and external stakeholders.
• Own all contract administration and related projects.
• Oversee quality and timeliness of deliverables for any applicable third-party vendors, as required.
• Perform other duties as assigned.

Qualifications:

Position Qualifications:

Qualifications of the successful candidate will include:

Education: A bachelor’s degree or equipvalent experience is required.

Experience:

• Minimum of 8 years of relevant contracting experience working for a payor, multi-site healthcare clinic or hospital, with preference for specific experience leading contract negotiations for women’s health, lab, and imaging services.
• Demonstrated success in contract negotiation and results-driven performance.
• Willingness to participate in all aspects of the contract administration process. This is a hands-on role rather than a supervisory or management position.
• Strong understanding of the healthcare industry, including ability to navigate high-level regulatory requirements, ideally specific to women’s health.

Skills and Attributes:

• Ability to work efficiently in a fast-paced environment and effectively collaborate with a team.
• Demonstrated leadership ability and interpersonal effectiveness required to work collaboratively with multiple disciplines, e.g., physicians, corporate leadership teams, and payors.
• Strong project management and organizational skills; must be able to manage and prioritize multiple business objectives and projects with the proper sense of urgency and autonomy
• Strong problem solving abilities with independent judement and action-taking capability.
• Persistent, self-directed, and able to work independently, while seeking guidance when necessary.
• Proficiency in MS Office Suite, Excel, PowerPoint, social media, and internet-based research. Power BI skills are a bonus.
• Exceptional written, verbal, and electronic communication skills, with the ability to present to both internal and external audiences.
• Compensation:

Compensation will be competitive and commensurate with experience and will include an attractive base salary and performance-based bonus (dependent on experience). We offer an attractive comprehensive benefits package, including medical, dental, vision, and 401K benefits (with match).h).

Qualified Applicants may apply for consideration!

More About TWH:

With the combined leadership of expert physicians, experienced Board of Directors, and strategic financial partner, Shore Capital Partners, TWH puts our medical affiliates at the forefront of innovation in women’s health.

OUR MISSION

To improve the lives of our healthcare partners and their patients.

OUR VALUES

Trust - We operate with integrity each day by doing the next right thing – for the patient and the business.

Respect - It’s not what you say, it’s how you make them feel. We listen and always care.

Collaboration - We are one team with a shared vision of success. No one of us is as effective as all of us.

Inspired - We bring enthusiasm and passion to the workplace. We believe we can achieve anything.

Accountability - We are responsive and keep our promises to our patients, our partners, and one another.

Excellence - We are committed to exceeding expectations and advancing the patient experience in all that we do.