What are the responsibilities and job description for the System Director of Managed Care position at Fairview Health Services?
Overview
This position has ultimate accountability for effective and timely execution of all managed care contract negotiations and contract execution for hospital, physician and continuum of services provided by Fairview and various affiliated partners. Is accountable for achieving budgeted net revenue expectations for all managed care contracts; assesses, evaluates, and directs the application of contracting principles, directs data analysis, contract language review and contract performance evaluation and reporting. In partnership with VP, Revenue Management, elevates strategic and tactical decisions of managed care relationships to achieve alignment and synergy with enterprise strategy. Responsible for payer relationship management and the development and execution of endorsed strategies and tactics. Continuously builds upon Fairview's knowledge of how health care is transacted to ensure the financial and operational objectives of Fairview and its partners are achieved.
Responsibilities Job Description
- Lead evaluation and analytics of Fairview and Payer positions in Fairview's service area.
- Develop and recommend strategic approach and tactics to address Fairview managed care payor terms and relationships.
- Develop, recommend, and oversee annual managed care negotiation parameters and contracting plans and execute negotiations consistent with budget.
- Direct implementation of key contract terms by assuring terms, rates and models are memorialized and carried out in accordance with the outcome of negotiations.
- Assess / recommend Fairview participation in new / existing managed care products to optimize revenue mix and advantageous value proposition for the system.
- Support market scenario planning and analysis.
- Lead connections with stakeholders to assure efficient and effective communication and implementation of Fairview's managed care contract relationships, including but not limited to Revenue Cycle, Optimal Care, FPAN, and others.
- Coordinate and report on financial, operational, and delivery aspects of payer contracts.
- Direct and resolve escalated payer issues to closure through negotiations, contractual updates, and / or dispute resolution processes.
- Maintain effective working relationships with all of Fairview's managed care payer relationships.
- Consistently demonstrate timely achievement of established goals, strong communication, ability to prioritize, and manage highly complex work in a matrixed environment.
Qualifications
Required
Education
Experience
Preferred
Education
License / Certification / Registration
EEO Statement
EEO / AA Employer / Vet / Disabled : All qualified applicants will receive consideration without regard to any lawfully protected status
Benefit Overview
Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information : https : / / www.fairview.org / careers / benefits / noncontract
Compensation Disclaimer
The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.
