Dir, Managed Care

Position Details

Department: CORP | Managed Care Admin

Location: Phoenix

Shift: Mon-Fri, Days, 8am-5pm

Category: Director/Management

Posting #: 1061491

Employee Type: Full-Time

Position Summary

The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PC, PCMG and PCCN contractual relationships.

Position Duties

• Directs all contracting activities for the enterprise-wide payor contract portfolio.

Directs contracting staff activities to achieve optimal contract financial and operational outcomes as well as effective contract management. Responsible for contract negotiations, including rates, payment methodologies, contract language and value based payment programs in accordance with internal control processes for contract review, approval and signature. Ensures contracts are negotiated within established parameters and acceptable time frames for maximum performance. Makes recommendations for contract strategies.

• Oversees the activities of the Provider Enrollment staff.

Oversees the activities of the Provider Enrollment team to ensure timely and accurate enrollment of facilities and employed providers with contracted payers. Ensure compliance with credentialing, recredentialing and delegated credentialing requirements related to Provider Enrollment. Monitor and update provider demographic information.

• Educates network providers and staff on key managed care principles, market trends, and opportunities for improvement in support of enterprise goals and objectives

Prepares and provides training on pertinent subject matter to network providers. Proactively communicates and educates operational areas on contract changes, policy updates, etc. To ensure staff have information needed to successfully implement and operationalize agreements. Participates in or conducts presentations as needed.

• Coordinates and leads activities using a collaborative and team approach.

Demonstrates attention to detail, strong interpersonal skills, and project management skills to effectively conduct team meetings, engage team members, secure cooperation, and accomplish department goals and objectives. Handles multiple projects and ensures teams perform as needed under tight deadlines with a focus on effective implementation, communication and follow-up. Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group`s achievement of goals and to help foster a positive work environment.

• Plays a key role in managing relationships for network hospitals, physicians, ancillary providers and vendors related to managed care agreements.

Ensures contracting, payor relations and provider services staff develop positive, effective relationships with internal and external customers. Provides direction needed by staff to interface effectively with internal staff, providers, payors, and health plans in negotiations, problem resolution and dispute management.

• Performs miscellaneous job related duties as requested.