Description
Washington Hospital Healthcare System Job Description
Job Code: 714
The Director, Managed Care Contracting, contributes to WHHS' growth
Job Title: Director, Managed Care Contracting
Position Summary
and profitability by providing contracting expertise to existing and new
contractual relationships; and providing subject matter expertise,
guidance, and direction regarding Managed Care Contracts. This
includes coordination of commercial, Medicare Advantage, Medi-Cal
Managed Care, Value-Based, Medicare Shared Savings, and other third
party managed care contracts and Payor relation activities for
Washington Hospital, Washington Township Medical Foundation, and
DEVCO entities (surgery centers and other ancillary entities). The
Director will be responsible for overseeing administration, review, and
financial analyses of managed care contracts for the healthcare
system, performing financial reporting and financial modeling for senior
management strategic managed care decision- making, and overseeing
all Payor relations and managed care denial follow-up and resolution
activities for the health care system. In addition to performing the
essential functions listed below, may also be assigned other duties as
required.
Statement of
Reports to: Vice President & Chief Revenue Officer
Accountability
JobDescriptionTemplate Revised10/13/24
Qualifications
1. Education:
Required: Bachelor's degree (minimum ten 10 years' experience
•
•
•
•Education
Licensure
Work Experience
Skills/computer/ specific
technical
can be substituted for formal education).
Desirable: Master's degree in health related field
2. Experience:
1. Other qualifications,
Minimum seven (7) years in a Managed Care Contracting
miscellaneous
capacity within a health plan or hospital; and at least the five
(5) years of experience managing and mentoring Contract
Manager or Payor Relations representatives.
Specify if qualifications are
Required or Preferred
Experience in an administratively responsible position with
significant intra-department work.
Demonstrated interpersonal skills.
Demonstrated skill in working with a large variety of
people of various organizations and levels.
Knowledge of legal terminology, understanding of
governmental and legislative regulations.
Previous experience in the areas of managed
care/finance/or patient accounting.
Demonstrated ability to perform financial analysis,
including managed care contracting financial
modeling.
Computer Skills: Financial Modeling, Windows 2000,
Excel, 2000, Work 2000, PowerPoint.
3. Skills and Abilities:
Must possess technical and professional skills and
knowledge of finance, patient accounting functions and
managed care. Must possess strong interpersonal skills, be
an effective public speaker and be comfortable in working
with diverse groups of individuals. Must be able to
competently represent Washington Hospital at administrative
functions. Must be able to work independently and
creatively.
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Essential Job Responsibilities
Achieving Results
Key Components: assess,
plan, evaluate, demonstrate
initiative, quality of work,
productivity
1. Responsible for negotiating Managed Care Contracts. This
includes routine contracting activities, maintaining strategic
relationships, evaluating contracts, and acting as an internal
resource in interpreting contracts.
2. Responsible for the initial reading and financial analysis of
managed care contracts for content, administrative issues, and
appropriate financial return.
3. Evaluate financial performance of existing contractual
relationships and monitor performance of new contractual
relationships. This includes production of financial impact reports
on an ongoing basis by both Payor and medical group.
4. Working closely with Managed Care and Finance leadership to
develop contract proposals based on WHHS' defined strategies,
goals and objectives.
5. Working closely with WHHS Strategy to participate in Employer
Direct contracting, contracting for new WHHS services, and other
strategic growth initiatives that require managed care contracting
support.
6. Prepare historical and financial data to provide support for
contract negotiations and contract renewals.
5. Ensuring appropriate dissemination of contract details to all
applicable stakeholders.
6. Always ensures the accuracy and completeness of all projects,
information, and analysis.
7. Support WHHS RCM and Compliance with price transparency
efforts and initiatives.
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Demonstrates Skill
KeyComponents:
competency, job knowledge,
organizational skills,
1. Direct and oversee Contract Manager to perform modeling,
financial impacts, utilizing Financial Planning and Analysis data
based on a project-by-project basis.
analytical skill, management
of information, employee &
patient safety
2. Develop recommendations regarding rates and contract language
for new and renewed contracts.
3. Administer managed care contracts, as well as develop and
monitor tracking and reporting mechanisms to ensure
appropriate reimbursement and adherence to contract terms.
4. Work with all relevant Washington Hospital Healthcare System
computer systems to garner needed information for financial
modeling, tracking, analysis, customer relations, etc.
5. Work with internal departments, particularly Utilization
Management and Patient Financial Services, to proactively
promote managed care and to ensure appropriate working
relationship between Washington Hospital Healthcare Systems
and Payor/medical groups.
6. Stand in for Chief Revenue Officer when needed at intra-hospital
and external hospital meetings.
7. Always complies with established department policies and
guidelines in developing projects, information and analysis.
8. Consistently challenges the appropriateness of assumptions and
formulas used in the preparation of all projects, information and
analysis.
9. Consistently monitors the monthly managed care data from
information systems and takes appropriate follow-up actions.
10.Provides sound, effective advice to management to assist them in
making effective decisions regarding managed care and strategic
issues surrounding managed care.
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Demonstrates Skill
Cont'
11.Always exercises care and accuracy in conducting collection and
analysis studies.
12. Takes resourceful/creative approach in collecting data, conducting
research, developing methodology and deriving conclusions and
recommendations.
Planning &
Coordinating
1. Resolve claims issues with contracted Payors and medical
groups.
Key Components: delegates,
decision making, problem
solving, management of
resources
2. Develop, monitor and perform training for all patient intake
Washington Hospital Healthcare System employees to ensure
correct Payor/medical group identification and tracking, and other
issues in managed care.
3. Design, conduct and coordinate meetings with physician office
managers to provide training in areas of managed care.
Professionalism
1. Consistently provides clear and thorough information in the
preparation of all projects, information, and analysis
Key Components:
dependability, interpersonal
skills, teamwork, patient first
ethic, customer service,
communication skills,
punctuality/attendance,
receptiveness to criticism,
judgment, confidentiality
2. Always displays study findings in a clear, organized format, and
prepares written communication/reports in a clear, concise and
organized fashion.
3. Consistently meets scheduled time frames in preparing all
projects, information, and analysis.
4. Consistently responds to inquiries from management regarding
information established from all projects and analysis.
5. Demonstrates good judgment when communicating with
patients/customers of various age groups by modifying delivery
and complexity of information based on age.
Improving the
Organization
1. Regularly identifies system enhancement opportunities and
recommends appropriate changes.
Key Components:
performance improvement,
quality initiatives
2. Participates in multidisciplinary performance improvement
activities.
3. Identifies opportunities for improvement in managed care
contracting and relationships through direct input from affected
departments, including registration, patient accounting, billing,
utilization management, medical records, and quality
improvement.
4. Participates in improving service by serving on committees or task
forces, collecting data when appropriate, and sharing ideas for
improvement.
5. Serves on Process Improvement Teams as requested.
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Self-Development
Key Components: maintain
license/certification,
1. Attends at least one educational program each year (i.e. HFMA,
Becker's or applicable other as approved by Chief of Payor Contracting).
education and training
Regulatory
Compliance
Key Components: JCAHO,
Title 22, OIG, HIPAA,
State/Federal laws, hospital
policies
1. Demonstrates awareness of, and compliance with, patient safety
and regulatory and licensing standards; i.e., TJC, Title 22,
OSHA, HIPPA and Washington Hospital's numbered
memorandums.
Prepared by: Semone Clark
Approved by: Marcus Watkins
Personnel Office Review:
Revised Date:
Title: Executive Assistant III
Title: VP & CRO
Date: 10/13/2024
Date: 5/4/2026
Date:
JobDescriptionTemplate-Revised10/12/04
