• Director Managed Care

    Requisition ID
    2018-12176
    Shift
    Day
    Category
    Finance
    Shift Hours AM/PM
    8:30AM-5:00PM
    Department
    SJ MANAGED CARE
    Position Type
    Regular Full-Time
  • Overview

     

    St. Joseph’s Healthcare System is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization’s outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation’s “100 Best Places to Work in Health Care”.

     

     

     Job Overview

     

    As an integral member of our leadership team, you will be responsible for negotiating and managing all Managed Care contracts for the system. In addition, you will coordinate with General Counsel on all Legal issues and approval of Managed Care Agreements, as well as communicate with various Department heads, including the Director of Patient Financial Services, Director of Care Management, and others, to ensure appropriate coordination and support of System-wide financial and operational objectives.

    Responsibilities

     

    • Responsible for overseeing the strategic planning, negotiation and execution of managed care contracts

     

    • Serve as lead for contracting for all St. Joseph’s Health entities including 2 acute care hospitals, one rehabilitation facility, behavioral health hospital & behavioral health outpatient sites, outpatient cardiology, and radiology/imaging centers, employed physician group.

     

    • Strategy development including market assessment, financial modeling, and relationship management w/employers and payers.

     

    • Responsible for developing and maintaining positive working relationships with all payers and for resolving third-party payer dispute issues that may arise pursuant to contractual relationships with payers.

     

    • Responsible for Facility & Physician Credentialing and Enrollment required for commercial contracting and enrollment with government payers.

     

    • Responsible for negotiating single case agreements when needed for patients who present for services with non-contracted payers.

     

    • Provide internal and external consultation regarding managed care, reimbursement strategies, and relationships to executive leadership across the system

     

    • Development of the necessary system to support the data gathering and data analysis needs of managed care contracting

     

    • Work with financial departments of all entities to ensure target contract rates meet costs/operating margin needs of entities.

     

    • Responsible for negotiating contracts which includes assessing legal and financial implications of all contracting opportunities.

     

    • Develops strong relationships with internal clinical providers and groups, Patient Financial Services and all departments impacted by contracts and contract terms.

     

    • Responsible for Dissemination of pertinent contractual terms, payer policies/procedures and payer regulatory updates across the Adventist Health system.

     

    Qualifications

     

    • Minimum 10 years Managed Care Contracting experience either in a Health System, Physician Group or Payor.

     

    • Experience in value-based reimbursement, pay-for-performance, risk-based/risk-sharing arrangements and bundled payment environments.

     

    • Bachelor’s degree in Business Administration, Finance, Healthcare Administration, or related field required. J.D., MBA and/or MHA a plus.

     

    • Superior leadership, analytical, oral/written communication and PC skills

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