Director of Managed Care Contracting and Analytics

Scheduled Weekly Hours: 40

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The Sturdy Health Director of Managed Care Contracting is responsible and accountable for Strategy, Negotiation and Monitoring of third-party contracts. Working in collaboration with the Revenue Cycle and Population Health Teams to assure that the hospital and physician group are paid according to contract and are successful under any value-based or risk arrangements. The Director will be primary liaison with the third-party payers relative to contract terms and a key contributor to decisions regarding plan participation.

Education/Training

·         Bachelor’s degree in Healthcare Administration, Finance, Business Administration or related field. 

·         Graduate degree is desirable.

Required Qualifications and Skills:

·         Minimum of 5 years of managed care contracting and negotiation experience.  

·         Strong negotiation, analytic, and relationship management skills

·         Extensive knowledge of provider (hospital and physician) payment arrangements and methods.

·         Deep knowledge of laws and regulations pertaining to healthcare industry.

·         Ability to communicate (in written and oral form) effectively with a wide variety of individuals and groups.

·         Demonstrated ability to independently handle multiple unique, sensitive and complex matters with minimal supervision and oversight.

·         Ability to relate to persons in a manner so as to gain support and promote confidence

·         Maintains confidentiality and assumes responsibility to carry out all assignments in a proficient and professional manner.

·         Identifies with, shares in, and has a commitment to the philosophy, mission and values of Sturdy Health.

 

Essential Job Functions:

·         Responsible for all third-party contracting across the system, including hospitals, physician group and value‑based arrangements. Lead contract negotiations with third party insurers to ensure hospital and physician groups are paid market competitive rates for services rendered.

·         Collaborate with executive leadership to align network contracting strategies with organizational goals. Monitor market dynamics to help inform contracting strategy. Develop and execute contracting strategies that anticipate market shifts, payer policy changes, and regulatory developments. 

Build and maintain positive relationships with third party insurers ensuring transparency, accountability, and alignment with organizational priorities to foster collaboration and resolve issues effectively and to position Sturdy Health to be able to effectively negotiate on behalf of hospital and providers.

·         Monitor and analyze third party payments to assure contract compliance.  Monitor payer performance, utilization trends, and reimbursement outcomes to identify opportunities for improvement and risk mitigation. Ensure accurate pricing of claims through Strata contract configuration.

·         Ensure compliance with federal, state, and accreditation requirements in all contracting activities.

·         Provide staff awareness and education on contract parameters and changes. Communicate complex concepts clearly to executives, physicians, and cross‑functional partners.

Serve as primary contact and resource regarding contract interpretation and other managed care reimbursement issues.  Work with internal clients to resolve issues, recommend process improvements related to reimbursement issues, and recommend future contract changes to enhance reimbursement and overall contract performance.

·         Work with the Population Health Team in the development, valuation, and tracking of all value‑based programs, including shared savings, bundled payments, downside risk, and capitation. Monitors performance programs, and risk arrangements with third party payers to meet strategic objectives that maximize financial performance. 

·         Work with Budget and Decisions Support Department to incorporate accurate projections / analytics to support hospital operations / strategic decisions. Perform / review analyses related to payer policy changes, regulatory updates, reimbursement shifts and to support negotiation strategy.

·         Assist with monthly net revenue/accounts receivable valuation. Prepare year end revenue related General Leger entries and audit work papers.  Respond to audit questions as appropriate.

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Other duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

 

AGE AND DIVERSITY RELATED CRITERIA:

Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.

 

ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.

 

PHYSICAL DEMANDS:

Prolonged periods of sitting at a desk and working on a computer.

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Salary Range: $139,296.01-$219,511.30

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Salary Range Details

The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

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Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.