Director of Managed Care

  •  

Tempe, AZ

Industry: Healthcare

  •  

5 - 7 years

Posted 134 days ago

  by    BETH GROSS

This job is no longer available.

Description

Cranial Technologies manufactures the DOC Band, a customized medical device that reshapes babies' heads. We are the leader in the treatment of plagiocephaly in infants because of our commitment to quality, our cutting-edge technology and the people that make up the Cranial Technologies family. We are in an exciting period of growth and expansion and are looking for someone to join our leadership team.

Our ideal Director of Managed Careshares our passion for changing babies' lives every day. In turn, we provide a strong collaborative culture where every contribution is recognized and valued. Our employees share a great sense of pride in the high-quality product they make and a deep commitment to the families we serve.

This position supports the operations of Cranial Technologies by performing activities involved in insurance management & payer relations. To that end, this position is responsible for identifying, targeting, and maintaining strategic transactional relationships with physician groups, managed care organizations, and hospital systems with the goal of establishing mutually-beneficial relationships as an in-network provider. This position works closely with the CFO, Manager of Insurance & Billing; VP of Clinical Operations; and, as needed, other members of the leadership team.

Responsibilities:

 

  • Educate Cranial Technologies on managed care; contracting; and related protocols, policies, and procedures
  • Research and establish new payer relationships in breakout markets for Cranial Technologies, including establishing payer contacts, reviewing requirements, processing documentation, and maintaining such relationships over time
  • Work closely with the finance department to understand and advocate for economically-sustainable rates and to provide insurance partners with data and analysis to support such arrangements
  • Negotiate terms of contractual arrangements (initial & renewal) with physician groups, hospital systems, Independent Practice Associations (IPAs), and managed healthcare firms within established limits, both on a group/organizational basis and as single case agreements
  • Educate payer partners (active and potential) about CTI, the standard service models, and CTI-specific services (in coordination with clinical leadership) to facilitate sustainable relationships and advocate for increased coverage where appropriate
  • Participate as an active member of departmental & cross-functional teams through sharing ideas, proactively raising concerns and solutions, and dedication to improving internal quality
  • Ensures provider database and documentation is up-to-date, accurate, and complete
  • Serves as resource and trainer for insurance specialist team in all functional areas
  • Identifies and communicates business and payer changes that affect immediate and future needs, processes, etc. and works with the affected departments & organizations to develop meaningful solutions
  • Coordinate with clinical leadership to ensure collaborative relationships, effective communication, and creative problem solving, both internally and externally, related to the interaction of clinical quality initiatives and payer policies and requirements

Minimum Qualifications:

 

  • Bachelor's Degree in the healthcare field
  • At least 5 years of previous experience in a healthcare organization with a focus on contracting and financial analysisrequired
  • Excellent oral and written communication and interpersonal skills required
  • Excellent analytical skills required
  • Knowledge of provider contracting, financial arrangements, and fee schedules, including understanding of healthcare reimbursement methodologies and guidelines preferred
  • Ability to act with sense of urgency to meet company needs
  • Must work well in a team environment, including being open minded & creative in problem solving
  • Ability to learn new organization systems, processes, and software quickly
  • Proficient in Word, Excel, and PowerPoint

 

We offer an excellent benefits package:

 

  • Medical, Vision, and Dental Insurance
  • 401k Retirement Plan
  • 3.5 Weeks Paid Time Off
  • Life Insurance
  • Short/Long Term Disability Insurance.