Director, Managed Care

Hospital for Special Surgery•New York, NY

23h•$112,000 - $170,875

About The Position

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.
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.

Nice To Haves

Major teaching/surgical hospital experience or health plan experience is highly desirable.
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.