Director, Managed Care

Hospital for Special Surgery•New York, NY

1d•$112,000 - $170,875

About The Position

How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let’s talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise. Reporting to the AVP, Managed Care & Executive Director, PHO, the Director of Managed Care plays a crucial role that demands a unique set of skills to ensure seamless interactions with insurance payers, PHO physician members, hospital administrative leadership, and various other stakeholders. This highly visible position is primarily responsible for the administration of HSS PHO and the negotiation and implementation of HSS PHO managed care contracts, ensuring their alignment with HSS clinical initiatives and strategic priorities. This includes engagement with various administrative and clinical stakeholders to determine contracting strategy to best support HSS PHO physicians.

Requirements

Experience (minimum 7+ years) with IPA/physician network administration and/or payer or provider contracting. Major teaching/surgical hospital experience or health plan experience is highly desirable.
Experience managing and leading a professional team.
Experience dealing with physicians and their office/billing staff.
Possesses key payer contacts and knowledge of payer contracting and enrollment processes.
Knowledge of the healthcare industry and payer reimbursement methodologies (both hospital and physician).
Ability to work independently and collaboratively to solve complex problems
The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
Excellent verbal and written communication skills
Excellent organizational and multi-tasking skills
Is professional when dealing with stakeholders; uses good judgement and takes a thoughtful approach to resolving and communicating issues.
Bachelor’s degree in health or business administration, economics or related subject is required. Masters preferred.

Responsibilities

Under the guidance of the Executive Director, oversees the day-to-day administration of HSS PHO operations including managed care contracting strategy and other additional administrative functions.
Meets with organizational leadership and stakeholders to ascertain and develop strategic payer contracting goals.
Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
Analyzes payer contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
Works closely with the legal team to review and edit contracts as appropriate.
Assesses contract administrative terms and payer policies to advise leadership accordingly on measures of contract performance.
Maintains up to date knowledge on the healthcare market, specifically in regard to payer policies and reimbursement trends.
Implements departmental policies, protocols and systems to enhance efficiency and effectiveness of workflows.
Possesses strong leadership skills and demonstrate capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development.
Places high priority on overall team performance.
Additional responsibilities as required to accomplish departmental goals.