The Corporate Director, Managed Care is responsible for creating, leading and conducting all managed care activities for Baptist Health Care Corporation (BHCC). This role will support and further the organization in its goals for growth, competition and financial strength. By securing optimal reimbursement and protecting the interests of the system in contract negotiations and the implementation and management of managed care contracts and relationships, this position is essential to the hospital's financial performance. The Corporate Director, Managed Care will contribute to strategic planning and strategy implementation as related to managed care; planning, organizing, directing and conducting the negotiations; and implementation of managed care agreements with current and prospective purchasers or providers of healthcare services on behalf of BHCC. The position will be charged with coordination and communication between the managed care department and other key stakeholders such as hospital operations and physician group leaders, as well as external constituents such as brokers and payers.
The person in this position works under general supervision and may be subject to over 40 hours per week and/or callback as required, and may also be required to remain on campus immediately before, during, and after severe weather and/or disasters.
- Bachelor’s degree in a Business field required; Masters degreepreferred
- Ten (10) years of progressive healthcare management experience with emphasis on health plan / provider contract negotiations, physician group contracting and managed care financial analysis
- Experience working in both the provider / hospital and health plan settings
- Successful experienceworking within a large, multi-level organization either in a health plan or provider
- Experience working in a competitive healthcare environment
- Comprehensive knowledge of the healthcare market, hospital operations, and managed care principles.
- Successful track record in managed care contracting activities including contract negotiations, monitoring of contract performance, financialreporting and resolution of operational issues
- Exceptional knowledge of hospital finance and accounting, including patient accounting principles and operations.
- Understanding of revenue, expenses, contribution margin and operating margin
- High degree of effective advanced analytical and problem-solving skills and judgment with specific application to hospital, medical and financial data
- Ability to effectively function in situations involving high-level negotiation activities and possess excellent negotiating skills
- Strong ability to consistently prepare and review accurate analyses, projections, and rate proposals
- Advanced knowledge of legal principles relating to managed care contracting issues at a level sufficient to exercise independent judgment in finalizing contractlanguage
- Capable of building and maintaining relationships while simultaneously achieving BHCC's short term and long term business objectives
- Advanced knowledge of information systems and their application to managed care and hospital
- Working knowledge of MS-DRGs and other coding methodologies as they apply to managed care
- Aability to ensure reimbursement rate structures are clear and may be efficiently adjudicated
- Direct understanding of the HIPAA regulations / guidelines
- Ability to organize, plan, and prioritize activities with specific attention to details and higher level strategies
- Consistently demonstrate effective time management skills
- Be a self-starter and possess the ability to conceive and create structure in an ambiguous environment
- Decisive, effective management and leadership skills
- High degree of effective oral and written communications skills