SVP of Managed Care

Job Summary

Director of Managed Care negotiates PathGroup Managed Care Contracts with Insurance Carriers and Government Programs. The person in this roles is responsible for the strategic direction of managing our reimbursement contracts in alignment with PathGroup vision and strategic goals. Director of Managed Care directly supervises and coordinates the activities of the Managed Care representative team including the daily activities of analyzing, identifying and solving managed care reimbursement problems and supervising day to day functions.

Essential Functions

• Support PathGroup's mission, vision, goals and management decisions.
• Provide leadership and supervise/manage assigned department, make decisions, solve problems, develop and document procedures, and conduct and attend meetings.
• Negotiate contracts with payers and resolve any contract disputes and/or issues.
• Develop strategic payer relationships.
• Manage the employee hiring process including developing and updating job descriptions, developing performance expectations, identifying essential functions and knowledge, skills and abilities required for applicable positions.
• Responsible for new employee orientation processes, employee training and continuing education.
• Manage employee performance by coaching, counseling, motivating, and evaluating employees on a continual basis. Implement disciplinary action as needed and in consultation with Human Resources.
• Ensure effective employee relations by sustaining an ethical, non-discriminatory and safe work environment and establishing effective communication lines and methods. Identify and solve employee problems, manage conflict, and respond to grievances as needed.
• Develop and implement procedures to ensure the highest levels of customer satisfaction, maximize the use of call center and productivity and accuracy in department.
• Develop communications between payers and company.
• Responsible for adherence to contract terms and mutual expectations and educating company key personnel about such contract terms and expectations.
• Engage in face to face contact with payer's key personnel.
• Monitor compliance of contracts with health care regulations and law.
• Oversee the credentialing process.
• Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Must be familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security policies.