Director of Managed Care Contracting

Overview

Summary: 

The Director of Managed Care Contracting will play a vital role in developing, implementing, and ongoing management/monitoring of managed care contracts. In this highly visible position, the Director, Managed Care Contracting will represent Reliant to both internal and external customers by developing and communicating an overall strategy for managed care contract activities, rate negotiations, and implementation of new contracts. Represents Reliant Rehabilitation’s commitment to quality & service in all interactions with the communities and clients, as well as adheres to Reliant Rehabilitation’s Policies and Procedures and to all state and federal regulations.

Responsibilities

Essential Duties and Responsibilities:

• Develops and administers managed care contracts in conjunction with senior management consistent with Reliant Rehabilitation’s strategic approach to managed care payer contracting.
• Works with stakeholders across the organization, including finance, revenue cycle, and operations, to ensure open communication and accessible information for all areas.
• Evaluates rate proposals and changes to reimbursement.
• Is a primary resource for the implementation of contract management software.
• Identifies or creates tools, financial modeling systems, or other resources to assist with payor contract evaluations.
• Assists internal customers with the resolution of payer issues. Initiates and leads meetings with contracted payers to address operational and/or payment issues and recommends changes to internal processes as needed.
• Establishes and maintains positive working relationships with internal and external customers to improve quality outcomes while optimizing reimbursement or lowering costs.
• Negotiates and administers single case agreements
• Chairs quarterly trend report calls and disseminates trend findings/opportunities.
• Interprets information in payor provider manuals, newsletters, and bulletins and communicates such policy or procedure to applicable Reliant team members.
• Responsible for the timely renewal of all payer contracts to ensure there is no delay in reimbursements.
• Gathers and analyzes data on insurance companies and managed care providers to use in the development of pricing strategies.
• Evaluates that the company has all necessary contracts required to increase referrals and admissions.
• Must conduct self in an ethical, legal, and responsible manner at all times.
• Must adhere to the policies, principles, and guidance within the Employee Handbook and Code of Business Conduct.

Qualifications

Competency: (If providing direct patient care at any time, a peer reviewer may complete the discipline specific competency checklist). 

To perform the job successfully, an individual should demonstrate the following competencies:

• Strong interpersonal, oral, and written communication skills.
• Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment.
• Demonstrated ability to lead and motivate others.
• Effective and efficient organization and time management skills.
• Confident, independent thinker and strong decision-making ability.
• Strong skill sets in regulatory compliance and industry payment models.
• Ability to build strong relationships with a diverse population
• Ability to read, write, speak, and comprehend in English: instructions, correspondence, memos, and reports
• Ability to work in a fast-paced, productive work environment
• Demonstrates positive, professional behavior with internal and external customers

Education/Experience:

• Bachelor’s Degree
• At least 5 years’ experience with multi-site, multi-state managed care contract negotiations and managed care contract management.
• Ability to follow, read and interpret managed care payer manuals and announcements.
• Experience with various revenue cycle areas such as patient billing, collections (posting and credit balance), denial resolution, and other essential reimbursement functions.

Work Environment:The work environment characteristics described here are representative of those a team member encounters while

performing the essential functions of this job. Reasonable accommodations may be made to enable individuals

with disabilities to perform the essentials functions. The noise level in the work environment is usually moderate.

The workplace is in an office environment and the temperature in the work environment is usually moderate.

Occasionally, travel by ground, air or other forms of transportation, which may include overnight stays, may be

required from time to time.