What are the responsibilities and job description for the Executive Director, Managed Care Operations position at 200 Academy?
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet. The Department of Business Development and Managed Care is currently seeking an Executive Director, Managed Care Operations to work at our offices in Medley, Florida. The Executive Director, Managed Care Operations develops, implements, and optimizes the financial performance and operationalization of all third-party, managed care contracts and single case negotiations across all University of Miami Health System hospitals, ambulatory service centers, employed physician practices and departments. The incumbent also assumes responsibility for directing all timely and accurate provider loading and configuration of UM credentialed, employed physicians within all contracted third-party, managed care payers. The incumbent is responsible for and oversees Business Operations, Provider Data Management, and Contract Lifecycle Management, including Health Plan contract Audits and Revenue Cycle support. Responsibilities also include the creation, implementation, and maintenance of all Managed Care and Business Development departmental policies and procedures to meet the standards of the health system and other outside accrediting bodies including JCAHO, AHCA, CMS, etc. Reporting to the UHealth Associate Vice President of Managed Care, the incumbent leads and manages the Managed Care and Business Operations teams and all downstream functions. CORE JOB FUNCTIONS Leads all Managed Care/Business development areas and functions, including Managed Care Strategic Planning, Contracting and Negotiations Management, Operations and Contract Implementation, Provider Data Management & Credentialing Downstream Payer Relations, Contract Lifecycle Management and Auditing for all UHealth/health plan partnerships for the University of Miami Health System. Maintains current knowledge of community developments as it pertains to competitive issues in managed care. Leads and manages care staff, including network contracting, contract implementation/operations, non-participation agreements, provider roster data management, reporting and special projects. Collaborates with internal peers and senior leaders, advising on medical economics and contract modeling, revenue cycle functions, audits and collections activities, and counsels medical department leadership on managed care protocols and strategy. Leads and participates in all managed care contracting negotiations for the health system. Oversees all single-case negotiations and operations’ process for the health system. Partners with legal counsel to review proposed and existing contract language. Leads training on new procedures, supplies, and pharmaceuticals being used for inclusion in the managed care contracting process. Oversees implementation stages of the hospital and physician managed care contracting process. Directs auditing process of hospital and physician managed care contracts to measure and maintain compliance. Establishes and maintains relationship with local and national health plan leadership. Hosts meeting with Health Plan and University leadership. Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations. Creates an effective control environment, conducts risk assessment, implements, and monitors controls. Identifies, evaluates, and responds to trends and future federal and state policies as they relate to changes which might impact the contracting function and UHealth rates Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations. Creates an effective control environment, conducts risk assessment, implements, and monitors controls. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor’s degree in relevant field Experience: Minimum 10 years of relevant experience Any relevant education, certifications and/or work experience may be considered. Knowledge, Skills, and Attitudes: Knowledge of business and management principles. Ability to direct, manage, implement, and evaluate department operations. Ability to establish department goals and objectives that support the strategic plan. Ability to effectively plan, delegate and/or supervise the work of others. Ability to lead, motivate, develop, and train others. Ability to maintain effective interpersonal relationships. Ability to exercise sound judgment in making critical decisions The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information. Job Status: Full time Employee Type: Staff Pay Grade: H21 The mission of the University of Miami is to transform lives through education, research, innovation, and service. A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation. The University comprises 12 schools and colleges serving undergraduate and graduate students in more than 350 majors and programs. Visit welcome.miami.edu/about-um to learn more about our points of pride. The University ranks No. 55 on U.S. News & World Report’s 2022 Best Colleges list and ranked No. 49 in the 2022 Wall Street Journal/Times Higher Education College Rankings. Bascom Palmer Eye Institute is ranked the #1 eye hospital in the USA and offers some of the nation's premiere eye doctors to treat every eye condition for adults. Sylvester Comprehensive Cancer, part of the Miller School of Medicine, received the prestigious National Cancer Institute designation in 2019. The University of Miami and UHealth have also ranked among the Forbes Best Employers and Best Employers for Women on several occasions, most recently in 2022. Transforming lives With more than 17,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe. The University is committed to fostering a culture of belonging, where everyone feels valued and has the opportunity to add value. Through values of Diversity, Integrity, Responsibility, Excellence, Compassion, Creativity, and Teamwork (DIRECCT) the U community works together to create an environment driven by purpose, excellence, community, and service.
