Responsible for enterprise-wide strategic development and tactical leadership of Managed Care Contracting & Operations and Managed Care Compliance Departments. Monitors performance of staff to achieve the organization?s mission, directives and goals.
1. Collaborates with executive leadership to develop current and future strategies for the organization. Researches and monitors insurance industry activities, healthcare reform, payer strategy and participates in legislative committees to gain knowledge in potential state and federal impacts.
2. Works closely with managed care staff to develop and implement strategies for all entities and monitors progress and outcomes.
3. Participates in complex negotiations with national payers to ensure financial viability of contractual arrangements and achievement of goals.
4. Develops and analyzes monthly financial packages for presentation to executives.
5. Works with health plan executives to overturn appeals and address Contract Compliance trends, issues and payments.
6. Reviews and monitors contract compliance reports to assure achievement of goals.
7. Manages all aspects of lawsuits, arbitration, mediation and settlements.
8. Monitors and prepares budgets for these areas.
Education: Bachelor’s Degree in Business Administration, Finance, Accounting or related field.
Licensure, Certification and Registration: None required.
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Required Work Experience: 15 years progressive leadership experience in managed care.
Memorial Healthcare System, consisting of 6 acute care hospitals, a nursing home, outpatient facilities, home health services and physician practices, provides quality, comprehensive care to the residents of the surrounding communities. We invite you to join one of the nation’s leading healthcare systems, recognized for use of advanced technology and clinical informatics.
Memorial Support Services provides a variety of business services to support our facilities. The main offices are located in Miramar with satellite offices located throughout our system.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Employment at Memorial Healthcare System is subject to post offer, pre-placement assessment, including drug testing.