Regional Director of Managed Care & Payor Relations

Overview

The objective of the Regional Director of Managed Care is to ensure that PAM Health and our key facilities participate in key managed care plan networks within their respective markets and maintaining/developing relationships with targeted Payor sources.  The position is responsible for securing, maintaining and renegotiating payor contracts that meet and or exceed the business and financial objectives of PAM Health.  

The Director of Payor Relations develops the payor  network (Managed Medicare, Managed Medicaid, Exchange Health Plans, ACOs, Bundled Payments and other Gain Sharing Programs, etc.) yielding a geographically competitive, broad access, stable referral and payment source that achieves objectives for unit cost performance and trend management.  This position evaluates and negotiates contracts in compliance with PAM Health requirements, reimbursement structure standards, and other key process controls. Responsibilities also include serving our PAM Health facilities and Corporate and Regional Operations for contract specific information to the Facilities, business office, admissions, operations and the central billing office (CBO).   The position will be responsible for developing, managing and maintaining the Payor summaries on an ongoing basis and insuring the sharing of key Contract Rate Schedules with any partner organizations that have a need to know the information as Business Associates.

Responsibilities

• Serve as a strategic, educational, and support to the District/Regional teams and corresponding care centers for Managed Care/Payor contracts and initiatives.
• This role involves the Voyages Behavioral Health Psychiatric Hospitals in terms of all Managed Care contracting responsibilities including I/P and O/P and Spravato Depression Outpatient program. Also responsible for “Smart Sheet Contract Summaries on Voyages Health Plan agreements.
• Responsible for establishing and managing relationships with local/regional/national managed care leadership and ensuring that colleagues in Central Billing Office, Facility Admissions, case management, have immediate access to their corresponding contacts for rates and terms.
• In collaboration with the EVP of Admissions and the Vice President of Managed Care,, identify and support the development and implementation of local opportunities for the districts through contracting, education and strategic initiatives including Public Payors for Psych Services.
• Support Episode of Care Management and serves as a resource expert to facilities, regional teams, and Corp Finance etc.
• Resolve escalated issues with payors related to payment and/or other systemic issues that are contractually based in concert with our Central Billing Office.
• Collaborate with the CBO Leadership on escalated claim issues and requested contracts.
• Report opportunities and threats related to Managed Care/Payors to SVP of Managed Care. When possible, provide analytics on the potential or risk to Consulate as well as recommendations.  Also provide Transparency Completive Information to SVP of Managed Care and Corporate Office. 
• Identify payors in specific districts for which contracts are needed and, in collaboration with SVP of Managed Care, take steps to secure agreements and relations that maintain and/or increase utilization for Consulate.
• Coordinate closely with Regional Operations Teams to coordinate efforts to achieve the goals of admitting more Managed Care Patients at Preferred Compensations terms.
• Assist and support the Central Billing Office team with escalated insurance payor issues and trends to help drive down days of sales of outstanding (DSO) to a reasonable level from each health plan.
• Participate in the development and management of a disciplined contracting process. Provide recommendations and feedback to ensure the process stays current and meets the business and financial objectives of Consulate. 
• Stay current on payor, reimbursement, CMS and other health care reform issues.
• Oversee, manage and negotiate all managed care agreements as assigned by supervisor. Take on new facilities for IRF and LTACH as assigned by SVP.
• Provide leadership within the contracting team, and manage the priorities, standards, and work.
• Develop a disciplined contracting process that meets or exceeds PAM Health’s business and financial objectives.
• Develop relationships with key payors’ decision makers for both contracting and referral management. Understand the payor strategy and opportunities and threats to PAM Health.  Communicate the opportunities and threats to your leadership.  Participate in strategies and plans to best position PAM Health with Payors.
• Use pertinent data and facts to identify and solve a range of problems related to managed care and payor contracts/strategy.
• Prioritize and organize own work to meet deadlines
• Provide explanations and information to others on topics within area of expertise which includes, managed care, product information, contract requirements, Health Plan Portals, policy requirements impacting billing and operations related to contracts, and payor strategy.
• Support centers with the Letter of Agreement process and negotiate rates when requested by facilities or regions.
• Responsible for reviewing existing and new contracts and completing Contract Summaries in a timely and thorough manner and secure rate increases when warranted from Health Plans and Work Comp Carriers when assigned.
• Identify solutions to non-standard requests and problems with respect to managed care contracts, payors, and billing issues.
• Translate Managed Care concepts into practice and advice on Benefit issues in the Health Exchanges and other Health Plan updates. Also work with the team on Provider Portal issues and the Tricare program and VA CCN programs.
• Provide explanations and information to internal constituents on difficult issues.
• Work in collaboration with supervisor and be responsible for providing timely progress, opportunities and threats.
• Act as a facilitator with Health Plan contacts to support CBO Collection Efforts. Stay abreast of Transparency regulations as well as Provider Directory requirements.
• Seek out additional opportunities to contract additional PAM Health facilities with the Major Health Plan Line of Business expansion in an effort to expand our Business relationship with certain health plans
• Identify Managed Care Score cards that may exist and are used to profile PAM Health facilities and provide them to the individual facilities and advise how they can improve around certain measures in the Scorecards.
• Perform other business related duties as assigned.

Qualifications

Education and Training: College Degree Preferred

Experience:   

• 5 years Plus experience in either a Network Role within a Managed Care Health Plan or Public Payor Program, or Provider Experience in Managed Care Contracting Role.

Knowledge, Skills, and Abilities:

• Managed Care Certifications a plus, attention to financial details a must, effective written communications, and should be an effective communicator and entrepreneurial mindset to grow the revenues for the organizations and seek out opportunities that present positive increases in margins to the company

About PAM Health

PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 80 locations, as well as wound clinics and outpatient physical therapy locations, in 17 states. PAM Health is committed to providing high-quality patient care and outstanding customer service, coupled with the loyalty and dedication of highly trained staff, to be the most trusted source for post-acute services in every community it serves. Its mission is to serve people by providing compassionate, expert care, and to support recovery through education and research. Joining our PAMily allows you to work in a collaborative environment with colleagues and leadership with exposure to a variety of patient care levels. Aside from our competitive pay, generous paid benefit time, and excellent insurance options, you will also have opportunities for professional growth through our Education Advancement Program. We are excited to learn more about you and hope that you consider joining us on a shared mission to improve the lives of others by being an integral part of our We Care Program. Please take a moment to visit us online at www.PAMHealth.com for a comprehensive look at how we're able to positively impact our local communities.

PAM Health does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person's actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.