Director, Managed Care Full Time

Summary:

• The Director, Managed Care is accountable for strategic partnerships with payers, including new business and revenue development through continued clinical integration and market expansion.
• The Director will own market strategy and partner with business operations, audit/compliance, and analytical support.
• Advises senior management of business opportunities and strategies for their market.

Responsibilities:

• Develops contracting plan and owns execution of rate increases for assigned geography.
• Leads and advances Strategic Partnerships for region, including clinical integration, enhancements in reimbursement, and innovative development, which includes negotiating alternative payment mechanisms, risk-sharing, and/or other reimbursement tactics to increase revenue.
• Provides guidance and direction to cross-functional business team members including Operations, Sales, Billing and/or Finance.
• Works closely with other team members to execute strategic initiatives, including but not limited to defensible pricing strategies, innovative contracting solutions, and contract operations improvements.
• Partners with Contract Operations to ensure timely and accurate setup and ongoing maintenance of contracts with contracted entities including, but not limited to payors, facilities, subcontractors, and other legal entities.
• Solves complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.
• Serves as a subject matter expert on contract and reimbursement-related issues impacting the home medical equipment and supplies business and healthcare industries, particularly with a managed care and commercial reimbursement focus.
• Manages a region and identifies and delivers on business opportunities and projects.
• Works with Audit and Compliance to ensure the company stays in good standing with associated entities, regulations, and patients.
• Effectively evaluates and oversees TPA, as the company moves forward with possible integration options.
• Develops and maintains working knowledge of current HME products and services offered by the company.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with AdaptHealth’s Compliance Program and applicable company policies, procedures, and patient protocols.
• Performs other related duties as assigned.

Requirements:

• Ability to see the field of the evolving healthcare landscape and understand the pressures, pain points, and unmet needs that can translate into new business opportunities.
• Executive leadership and presence, with the ability to move between managing operations and engaging with executives.
• Commitment to live and promote AHCO’s values positively and proactively to patients, teammates, and business partners.
• Business savvy, solution-oriented with a high-energy, accountable, and forward-looking attitude.
• Must be a practical thinker, able to devise realizable solutions and roll up sleeves to get things done.
• Ability to influence others to own the vision and strategies.
• Bachelor’s degree in relevant discipline from an accredited college required.
• Seven (7) years of relevant work experience in contracting, credentialing, or network management.
• Five (5) years of management experience in a related position preferred.
• Valid and unrestricted driver’s license in the state of residence.

Benefits:

• HMO coverage for eligible locations.
• Permanent work-from-home.
• Immediate hiring.
• Steady freelance job.

Tagged as: Business Development, Contracting, Healthcare Strategy, Managed Care