Managed Care Finance Director directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Being a Managed Care Finance Director implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Additionally, Managed Care Finance Director typically reports to top management. The Managed Care Finance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Managed Care Finance Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
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General Summary: The Managed Care Director establishes and implements the company-wide managed care strategy. This may include the identification and prioritization of payors by market; determining the viability of a given payor agreement; ability to leverage hospital performance and payor agreements across otherwise disparate markets; negotiation and re-negotiation of payor agreements; and the harvesting and communication of performance data to stimulate payor negotiation referrals.
Patient Population: Does not have contact with patients.
Essential Functions:
This description is a general statement of required essential functions performed on a regular and continuous basis. It does not exclude other duties as assigned.
Requirements
Supervision: Directs the activities and the staff of the department.
Experience Minimum of five years’ experience developing and implementing managed care contracts in multi-market health care systems. Experience negotiating system-wide contracts as both payor and provider is preferred.
Education: Bachelor’s degree in Health Administration or business-related field required; master’s degree preferred.
Licensure/Certification: Certification in the American Hospital of Healthcare Executives preferred.
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