Director Managed Care

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Job Summary:
1. Develops and implements strategies to improve Managed Care net revenue, payor and business relations, and cash collections for University Medical Center.
2.Core responsibilities include: Negotiating/renegotiating and evaluating Managed Care agreement
3.Interfacing with payors on contract compliance and payment issues
4.Developing an annual Managed Care market plan
5. Responsible for performing on-going monitoring of financial performance of the Managed Care agreements and the development of strong working relationships with payors and business partners in the surrounding markets.
6. Negotiate individual case agreements/transplant agreements
7. Maintain database of key performance indicators (KPI) for each case
8. Establish new and innovative methods to drive revenue and gross profit margins
Reports to: VP, Business Development
Job Specific Responsibility:
• Assist the Senior Vice President with regular monitoring/updating of Managed Care contracts
• Assist as assigned, with new contracts to increase inpatient and outpatient net revenue
• Work jointly with TTUHSC and UMC Physicians to keep abreast of current and on-going contract
negotiations/issues
• Utilize and analyze any available internal reports to assist in updating and reviewing contracts as
needed to increase revenue
• Utilize and analyze any available internal reports to assist in updating and reviewing contracts as
needed to increase revenue
• Work with UMC departments to create an on-going awareness in the community of services
offered by UMC
• Monitor target employers and assess their needs for business development opportunities
• Performs other related duties as required or requested.
Education & Experience:
Bachelor's degree preferred
A strong understanding of contracting process.
Must exhibit strong confidence, ability and experience working with payors/networks, as well as with senior level staff.
5+ years payor/network experience, management, and operations experience required.
Experience negotiating in local market preferred.
Skills & Abilities:
• Must be able to maintain a pleasant disposition and positive attitude
• Be able to communication and listen well
• Demonstrate creativity and organizational skills to control several projects simultaneously
• Must be mobile enough to visit employers and travel as required
• Requires self-motivation and individual discipline
Interaction with Other Departments:
Interactions internally with Patient Financial Services (Patient Accounting), Marketing, Financial Counseling, Information Systems (IT), Dimension, Compliance, Case Management, Medical Director(s), and Physician Network Services (PNS). Also interact externally with Texas Tech Health Sciences Center (TTHSC), TeamChocie, various payors, health plan, and other providers.
Physical Capabilities:
Occasionally exerts up to 25lbs of force and/or frequently exerts a small amount of force to lift, carry, push, pull, and move objects. Work involves sitting most of the time, but may involve walking and/or standing for brief periods of time. This position requires frequent typing/keyboarding and some reaching in all directions. Must be available to work 8:00 am to 5:00 pm Monday through Friday plus after hours as needed. Be available by cell phone as needed.
Environmental /Working Condidtions:
This position is subject to inside environmental conditions, protection from weather conditions, not necessarily from temperature changes.
Direct Reports: 4 staff
UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
*Request for accommodations in the hire process should be directed to UMC Human Resources.*