Director, Managed Care
Job Posting for Director, Managed Care at Adventist Health
Adventist Health is ranked #10 in Becker's list of the largest nonprofit hospital systems in the U.S. We are the largest company headquartered and sixth largest employer in Roseville, California. Our corporate headquarters have been located at a desirable location on Douglas Boulevard since 1984. To accommodate our growing services, we are creating a new campus that will not only bring our workforce of nearly 900 people together in one location, but also facilitate a deeper connection with our Roseville neighbors and community.
Job Summary:
Assumes responsibility for hospital managed care contracting, payer in-servicing, contract implementation and contract reporting at designated hospitals. Works in association with the hospital chief financial officer (CFO) on contract matters. Serves as liaison with hospital affiliated independent practice associations (IPAs) and medical groups. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
Job Requirements:
Education and Work Experience:
- Bachelor’s Degree or equivalent combination of education/related experience: Required
- Master's Degree: Preferred
- Seven years' technical experience: Preferred
- Five years' leadership experience: Preferred
Essential Functions:
- Maintains responsibility for payer contracts with Adventist Health Physician Network, rural health clinics and other Adventist Health affiliated physician organizations. Manages, directs, and leads the departmental staff to ensure maximum productivity and efficiency. Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Directs, organizes, and plans the operation of assigned department at the center and market level.
- Responsible for payer contracts for home health services and coordinating contracting activities with managed care and/or physician organizations. Coordinates care, services, and programming across departments and services.
- Ensures compliance with local, state, and federal regulations.
- Plans/monitors/maintains, FTE, capital, and operational budgets. Reviews department systems, concerns, budgets, and goals with physicians, including cost reduction and revenue enhancement.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
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