A leading Oncology Physician Practice has an exciting career opportunity for Director of Managed Care based in Tucson, AZ.

SCOPE:

Under minimal supervision, recommends, develops, coordinates and implements activities in support of strategic direction for managed care plans at the state level for 10 or more managed care markets and at least $400 million in managed care annual gross revenue.  Will support multiple Executive Directors in the state.  Represents company in market assessments, managed care contract negotiations, and related activities.  Works with state contracts administration to ensure effective implementation and management of contracts.  Ensures services are negotiated, marketed, and sold in accordance with budgeted objectives in order to obtain maximum profitability and volume. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Analyzes markets from a strategic perspective, develops managed care strategies and tactics by market and at the state level.
• Develops and implements managed care goals and objectives at the state level and ensures their execution.
• Recommends and gains support of physicians and operations to ensure optimal implementation of the managed care strategy.
• Maintains awareness of market, payor, and competitive managed care activities and adjusts strategies accordingly.
• Works with state contract administrators to ensure effective implementation of new and renegotiated contracts and to resolve problem payor issues.
• Communicates effectively with management, physicians, and business office/contract administration on the status of contracting and problem payor issues.
• Reviews and negotiates contract language and pricing terms in accordance with budgetary objectives and policy and procedure to maximize benefit to the company.
• Represents the physician practice and company to payors and regulatory authorities in matters related to managed care services at the state level.
• Effectively communicates trends and issues to corporate managed care through ad hoc communications, monthly and quarterly reports.
• Works with corporate managed care to recommend changes in contracting and reimbursement guidelines to ensure achievement of reimbursement maximization as it relates to managed care.
• Provides work direction and leadership to state Managed Care staff.