What are the responsibilities and job description for the Director Managed Care position at Cooper University Hospital?
About Us
At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description
Provide seasoned expertise and leadership in the development and implementation of the
managed care and direct marketing policy and strategy. As a key member of health system's Leadership Team, will diligently work in order to achieve economic benefits in the marketplace from the collective strength of the system.
Participate directly with Health System Leadership, Affiliates and Medical Groups to develop and implement the same. Has overall responsibility for the system with regard to functions and duties of provider network, payer contracting and direct marketing.
Responsible for establishing organization-wide processes to meet the goals of the organization. Responsible for the planning, development, direction, management and coordination of all aspects of the network and direct marketing as they relate to outside commercial contracting, provider contracting and relationships with payers, providers, employers and the community.
Has overall responsibility of leading and managing the commercial contracting provider network and payer contracting process for all entities. Coordinate clear internal communications and ensure timely implementation of negotiated contracts with the involvement of appropriate personnel.
Thoroughly ensure that state and federal regulatory aspects are researched and monitored
and all areas are in compliance in order to minimize any risks to the system.
Has overall responsibility for ensuring Epic and Strata contract management systems are fully optimized as data output is needed for reporting, creating dashboards, contract modeling and negotiations.
Responsible for accuracy of the contract build as it impacts hospital and physician A/R follow up team's workflow. Goal is to identify all payer payment issues to ensure A/R follow up collects all money due Cooper.
Experience Required
5 years of proven experience in progressively responsible positions in health care or
health plan environment, with seasoned financial and managed care contracting experience and Managed care strategy development is a must.
Must have demonstrated management experience and leadership of the negotiating/contracting process including a strong ability to organize and prioritize activities while ensuring attention to details and communication with all key stakeholders.
Requires demonstrated experience in system design, integrating activities and maintaining effective relationships with operating entities and physicians, as well as providing effective
teambuilding/teamwork with other members of the contract team.
Requires an in-depth understanding of the health care market, health plans, managed care
delivery systems and/or alternative financing systems, as well as knowledge of relevant federal and state regulations.
Must demonstrate an understanding of overall reimbursement models and ability to translate day-to-day revenue cycle functions into managed care strategy.
Must be able to develop processes to assure all relevant state and federal regulations are complied with by all parties. Must demonstrate a strong understanding of basic financial principles, as well as statistical, accounting and data systems.
Requires extensive knowledge of the managed care environment, negotiation process, and
contracting principles. Previous experience in negotiating contracts.
An understanding of NCQA and URAC credentialing guidelines is a plus. Demonstrate ability to establish an organizational structure that allows for informed decision-making using data analytics and insight from Epic system.
Education Requirements
BS Degree in Business, Finance, or Healthcare required.
Master's degree in business administration or health care administration is preferred.
