What are the responsibilities and job description for the Director Payer Contract/Credentialing (Managed Care Dept) position at Academy of Managed Care Pharmacy?
Remote Candidates Welcome to Apply
Job Summary
Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide guidance and support to Senior Leadership in aspects of payer contracting / negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.
Job Specific Duties
- Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
- Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
- Creates and maintains professional relationships with payers and potential affiliates.
- Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
- Implements and communicates contracting strategies in collaboration with Senior Leader.
- Manages all out of network contracting for both hospital and employed physicians.
- Responsible for the management and development of subordinates.
- Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
- Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements / issues- current and historical.
- Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
- Responsible for making high impact decisions steeped in judgment.
- Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
- Complies with legal and regulatory compliance requirements.
- Leads and oversees Corporate Pricing function.
- Leads and oversees Corporate Credentialing function.
Qualifications
Minimum Job Requirements
Knowledge, Skills, and Abilities
Job : Management
Primary Location : Florida-Miami-NCHS Corporate Headquarters
Department : NCHS-MANAGED CARE CONTRACTING-1000-900910
Job Status : Full Time
J-18808-Ljbffr
