Director of Managed Care
Empath Health is a nonprofit integrated network of care that provides expert, life-changing health care to those with chronic and advanced illnesses. Empath Health includes hospice, palliative home health and physician services, independent living assistance and day care for seniors, HIV services and advance care planning.
Empath Health is currently seeking a Director of Managed Care to be responsible for the infrastructure and expansion of managed care contracts for all services within Empath Health. and to serves as the primary liaison for all managed care services throughout the Empath Health service area.
The Director of Managed Care seeks out new opportunities to contract Empath services with all potential organizations and evaluates, analyzes, negotiates, implements, and monitors contract rates and terms within established contract parameters and time frames. Contracting may include hospice, home health care, palliative care, pediatrics, pharmacy, PACE and other related programs, as well as all vendor contracts associated with the Company.
Other essential duties and responsibilities of this role include:
1. In collaboration with leadership, identifies appropriate contracting and re-contracting opportunities and initiates discussions with key constituents.
2. Creates and maintains high level contacts with existing and potential contracting partners.
3. Collaborates with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with program goals.
4. For new relationships or service lines, performs business and market analysis to determine viability of contracting.
5. Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals. Collaborates with internal staff on modeling of rate proposals. Ensures contract terms can be administered and monitored in a cost effective manner. Effectively interfaces with management, finance, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
6. Manages all aspects of the contract life cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
7. Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
8. Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serves as the expert on all terms of the payer contract for both internal and external parties.
9. Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
10. Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision-making.
11. Performs miscellaneous job related duties as requested.
Mission: Through every step of every journey, we offer compassion through extraordinary care, hope through innovative services and inspiration through endless encouragement.
Vision: To be the leader in life-changing health care.
As a Managed Care Contract Director with Empath Health you must be patient/family focused, loyal, motivated and interested in serving your community and have a proven record in this sector.
Other requirements of this role include:
• Education and/or Experience: Bachelor’s degree (B.A.) from four-year college or university in healthcare or business preferred; or one to two years related experience and/or training; or equivalent combination of education and experience.
• Strong interpersonal skills and attention to detail
• At least two years’ prior experience in contract management preferred.
• Technical proficiency in Microsoft Office Applications
Empath Health wants your career to be as rewarding as possible. We provide our employees with numerous opportunities for growth, education and advancement. We offer competitive salaries, an excellent benefits package and peace of mind.
Other benefits include:
• Health, Dental and Vision Insurance
• Group Term Life and AD&D Insurance
• Voluntary term life insurance
• Short-term and long-term disability
• Professional group liability insurance
• Paid Time Off
• Flexible spending accounts
• Retirement savings plan with employer match
• Mileage reimbursement
• Cell phone plan discounts
• Employee Assistance Program (EAP)
• Tuition reimbursement
• Local, state and national workshops and conferences
• Advanced certification courses
• Leadership development programs
• Much more!
Drug & Tobacco Free Workplace.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.