Director of Managed Care

PURPOSE AND SCOPE:

Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc). Oversees Division's contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments. Develops and directs regional marketing efforts to third party payors in order to support growth and profitability in the region.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
• Reviews and analyzes potential contracts for financial effect, cost benefit and utilization.
• Negotiates contractual relationships with managed care organizations and other third party payors as needed.
• Presents contract proposals and market and industry analyses to internal parties and responds to Requests for Proposals from third party payors.
• Manages activities concerned with contracts for delivery systems.
• Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.  Has significant project/process responsibility within the function.
• Interprets company-wide policies and procedures. Involved in the development, modification and execution of company policies that affect immediate operations with potential company-wide effect. Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results.
• Ensures compliance of facilities with all managed care organization requirements ensures credentialing processes are implemented.
• Ensures all facilities meet and maintain appropriate credentialing requirements and licenses.
• Develops and implements methods and procedures for monitoring work activities and informs management of current work activity status.
• Responsible for continuous communication and coordination of all required ongoing documentation with appropriate staff.
• Works with internal and external counsel as needed to resolve issues and support FMS.
• Negotiates and implements contracts with payors that require clinical and quality outcomes measurements.
• Contributes to the design and implementation of third party payor compensation structures.
• Assists in the development of report cards that can be shared with third party payors illustrating outstanding quality of patient care through associated outcomes. Ensures quality outcomes are reported accurately and in a timely manner.
• Assists with designing Quality Improvement Projects that will improve outcomes in facilities that are not meeting goals.
• Develops and implements regional marketing plans to support regional growth and profitability and marketing of FMS services to third party payors and potential referral sources.
• Maintains knowledge of FMCNA products, services and strategies in order to market appropriately.
• Maintains current knowledge regarding community healthcare market and industry issues that may impact the business.
• Generally manages department budget and day-to-day functions. Develops budgets, schedules and performance standards.  Exercises supervision in terms of costs, methods, and staffing.
• Responsible for implementation and achievement of business plan, budget, key performance indicators and communication to appropriate executives.
• Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution.  Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.
• Provide technical guidance.
• Assist with various projects as assigned.
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions. 

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISION:

May be responsible for the direct supervision of various levels of managed care and marketing staff.

EDUCATION:

Bachelor's Degree in Business or Health management required; Advanced Degree desirable.

EXPERIENCE AND REQUIRED SKILLS:

• 6 - 8 years' direct experience in contract negotiation and operational experience in a multiple site outpatient facility setting including profit and loss responsibility.
• 3+ years' experience as a Manager preferred.
• Demonstrated ability to manage one or more departments.
• Ability to manage databases and provide analysis.
• Proficient with PCs, Microsoft Office applications and business computer systems.
• Strong oral and written communication skills.

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.