Executive Director, Managed Care
5 - 7 years experience • Managed Care & Health Insurance
Seeking a skilled and experienced Executive Director of Managed Care to join our exciting, innovative health system environment where you'll lead an effort to successfully complete a transition from a volume model to a value model of care. You'll be in charge of mentoring a young, but strong and highly motivated team of healthcare professionals, working with local employers to sell a commercial ACO (Accountable Care Organization) product where savings are shared directly with providers when we can impact both the cost and quality.
The Executive Director of Managed Care will report to the Chief Business Development and Planning Officer for our regionally renowned health system.
Responsibilities will included the centralization of all managed care activities, implementation of guidelines for PHO physician credentialing and re-credentialing, design, implementation and coordination of a utilization review function and related activities, including sale of such services to employers, third-party administrators and insurance companies.
Negotiates contracts with insurance companies/payers for Health System services. Conducts system-wide managed care activities and Medical Group credentialing and contracting.
Directs a system-wide utilization review/ quality management program. Oversees sales function that sells system services to area businesses.
Assists in arranging affiliation relationships with otherhealthcare and healthcare-related organizations, oversees affiliation relationships, and new business development.
Education and Experience
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor's degree in Business, Economics, Marketing or a related field. Master's Degree in Business or Health Administration; and five to seven years of experience in managing managedhealthcare programs, traditional health insurance, marketing and hospital/physician relations is preferred.
A previous successful contract negotiating record is required. Five to seven years of supervisory/leadership experience is required.
Knowledge & Skills
- Requires the knowledge in healthcare delivery systems, managed care products/services/systems, health benefit plans, hospital/physician relations, utilization review/quality management and effective sales/marketing techniques necessary to perform the essential functions of the position.
- Demonstrates independent judgment and analytical skills necessary to develop programs, evaluate projects, and approve or recommend changes in policies and procedures and staffing levels that affect managed care and utilization management.
- Demonstrates the interpersonal and communication skills (both verbal and written) necessary to give effective presentations before small and large groups, to effectively interact with representatives of client organizations, business leaders, various public managers and leaders and physician groups in situations requiring negotiations and persuading in a tactful and positive manner.
- Demonstrates the administrative and management skills necessary to direct a number of organizational programs and supervise management, professional and paraprofessional staff.
Starting salary range is expected to be $128, to $170,, depending on experience and education.
Excellent benefits will accompany the position and relocation assistance will be provided.