Senior Director, Managed Care - Coastal Region

Company: PALTmed
Location: Orlando
Posted on: February 19, 2025

Job Description:

DescriptionScionHealth is recruiting for a Senior Director of Managed Care, to join our managed care team. This is a remote position and will support our Coastal Market. Some travel will be required. Candidates who reside in the Florida market area are preferred but candidates who reside in other areas will be considered.ScionHealth is focused on driving innovation and investing in people and technology to deliver compassionate patient care and excellent health outcomes in ways that lift a community and improve health equity. We operate 75 Specialty hospitals across the company. We believe that great work comes from passionate people who are inspired to give their best every day.Job SummaryThe Senior Director, Managed Care is responsible for the development, implementation and coordination of managed care contracting and related activities for Kindred Healthcare in a defined market under the director of the Vice-President of Managed Care. This position will supervise key managed care positions in a defined geographic area. He/she will be responsible for leading the execution of Kindred's payer contracting strategy in cooperation with the leadership team to optimize relationships and revenue with managed care payers in a manner consistent with Kindred's strategy. He/she will demonstrate the ability to organize and oversee a team that will successfully execute Kindred's managed care strategy. The Senior Director will serve as the primary liaison between the managed care marketplace and appropriate corporate and functional areas including operations, finance, revenue cycle, sales, legal, compliance, etc.The Senior Director must understand thoroughly the strategic, regulatory and operational issues of Kindred and the payer community to maximize contracting and revenue opportunities for the company. It is vital that this individual relates to all internal and external constituents in an honest, open and effective manner, understanding what they seek and how to translate that into more profitable contracts and more effective relationships with existing and prospective clients. These duties are performed within Kindred's budgetary and business guidelines. This individual must have knowledge of the managed care market, network management, insurance operations, compliance, contracting and contract performance.Essential Functions

• Oversee a focused team of payor relations staff aligned with the assigned markets.
• Provides supervision, development and mentoring of staff.
• Directs the coordination and integration of managed care services with other departments and the primary functions of their market facilities.
• Meet annual revenue objectives by identifying and prioritizing target health plans by researching and evaluating service opportunities, market size, competitive environment, contract profitability, and other applicable factors to increase market share, maximize profitable revenues, and meet or exceed overall business goals and objectives through contracting and implements changes through contract negotiations.
• Responsible for managed care team building, and company managed care marketing initiatives.
• Responsible for the development and management of financially viable managed care contracts.
• Manages increasingly complex contracts, negotiations, and execution for fee for service and value-based reimbursement with health plans.
• Maintains regular and open lines of communication with key customers by developing and managing close, internal and external, business relationships in order to monitor market conditions while remaining alert to new business opportunities and to ensure ongoing account servicing in a manner that maximizes customer satisfaction while positioning Kindred favorably in the marketplace.
• Align with the Central Business Office on shared data and information needs and assist with payment and other disputes, as necessary.
• Works closely with the senior staff in developing comprehensive sales and business plans as well as quarterly and annual revenue forecasts designed to meet and exceed the profit and growth objectives of the company.
• Works with health plans to identify specific managed care outcomes, participate in joint marketing and program presentations, and help to resolve issues.
• Identifies and attends critical national/group conferences and meetings to educate health plans to the programs, services and outcomes of Kindred facilities. Provides operating area updates on activity, changes in industry, and new business opportunities. Develops, analyzes, and implements special reports/projects such as governing board reports, executive summaries, marketing action plans, strategic partnerships and alliances, as may be required.
• Meets with key decision-makers in the community including contracted and non-contracted medical groups, workers compensation organizations, health plans and hospitals.
• Participate in performance improvement activities to measure and assess the quality of services provided. Assures that clinical programs are responsive to the needs of payors, patients and families and referral sources. Assists in the development of specific programs that meet the expectations and requirements of the payor community.QualificationsEducation
  • Bachelor's degree in business or healthcare field required. Master's degree preferred.Experience
    • 10+ years of healthcare experience, including at least 8+ years of experience in healthcare administration.
    • 3+ years of experience in managed care organization, delegated provider or third-party payor.
    • Knowledge of managed care contracting required in any of the following settings: Long Term Acute Care, Skilled Nursing/Transitional Care, Inpatient Rehab, Home Health/Hospice.Knowledge/Skills/Abilities
      • Self-motivated and results oriented.
      • Ability to apply knowledge of medical terminology and payor reimbursement methodologies including managed care requirements and strategies.
      • Strong organizational skills.
      • Excellent oral and written communication and interpersonal skills.
      • Ability to communicate in English effectively through verbal and written means.
      • Ability to work under stress with conflicting priorities and deadlines.
      • Ability to think critically.
      • Ability to review and understand contract language.
      • Ability to make presentations.
      • Ability to conduct negotiations.
      • Computer skills including Microsoft Office software.
      • Approximate percentage of time required to travel: 20%Depending on a candidate's qualifications, this role may be filled at a different level.
        #J-18808-Ljbffr

Keywords: PALTmed, Orlando , Senior Director, Managed Care - Coastal Region, Accounting, Auditing , Orlando, Florida