Northeast Georgia Health System, Inc.

Executive Director - Managed Care Operations

Northeast Georgia Health System, Inc. • $120K — $150K *
Gainesville, GA 30506In-Person
Healthcare
5 - 7 years of experience
Reposted 5 days ago
Job Overview by Ladders

Qualifications

  • Bachelor's Degree required
  • 7+ years of experience in managed care contracting or finance
  • Extensive knowledge of the Managed Care environment in Georgia or similar markets
  • Strong organizational and planning skills
  • Excellent analytical abilities using spreadsheet and contract management software.

Responsibilities

  • Conduct research and negotiate managed care contracts
  • Attend meetings with Managed Care Organizations to gather market insights
  • Review contract language to optimize reimbursement and internal efficiency
  • Analyze service volume and pricing for contract performance improvement
  • Coordinate and manage the administration of contracts throughout the organization.
  • Develop strategic goals for Medicare Advantage and community contracting plans
  • Facilitate communication between various departments and Managed Care Operations.

Benefits

  • Collaborative workplace focused on personal and professional growth
  • Opportunities for career development and advancement
  • Supportive environment promoting team investment.
Full Job Description
Job Category:
Administrative & Clerical, Executive Leadership

Work Shift/Schedule:
8 Hr Evening - Morning

About the Role:
Job Summary

The Director of Managed Care conducts and coordinates the functions involved in Managed Care operations and contracting activities at the System level. Monitors and updates the administrative staff on political, legal and regulatory trends with respect to managed care and vertical integration. Works with Medical Economics, Finance and Revenue Cycle to produce reports for the Executive Director concerning managed care contract modeling and contract performance. This position is responsible for managed care financial analysis and analyzing contract proposals. This position is responsible for the medical economics staff and operation. This position will work with the various Revenue Cycle components/departments to ensure negotiation of the most appropriate contract terms/structures, etc. This position will work as a liaison between with managed care payers and system to facilitate resolution of contractual and operational issues in order to enhance managed care contract performance.

Minimum Job Qualifications
  • Licensure or other certifications:
  • Educational Requirements: Bachelors Degree.
  • Minimum Experience: Seven (7) years of managed care contracting and/or managed care finance experience.
  • Other:


Preferred Job Qualifications
  • Preferred Licensure or other certifications:
  • Preferred Educational Requirements:
  • Preferred Experience:
  • Other:


Job Specific and Unique Knowledge, Skills and Abilities
  • Possess extensive knowledge of the Managed Care environment in Georgia or similar market
  • Possess successful relationship building skills
  • Self motivated with strong organizational and planning skills
  • Good written communication skills including email
  • Excellent analytical skills through use of various spreadsheet software (i.e. Excel), querying software and/or contract management programs
Essential Tasks and Responsibilities
  • Responsible for research, analysis and negotiation of contractual agreements.
  • Attend meetings with representatives of Managed Care Organizations, gathering information on their market presence and future development.
  • Coordinate the review of managed care contract language to achieve optimal reimbursement for NGHS and to promote internal efficiencies among internal departments that are affected by said contracts.
  • Perform service specific reviews of volume and pricing in an effort to maximize contract performance.
  • Coordinate, prepare for and attend regular negotiation meetings with contracting parties.
  • Coordinate the administration/management of contracts through NGHS system, ensuring the dissemination of appropriate contract information to necessary internal/external users.
  • Responsible for producing accurate final original documents.
  • Development of the Medicare Advantage strategic goals and objectives, including the community focus and contracting strategic plan.
  • Support VP of Managed Care in new contracting initiatives such as pay for performance.
  • Establish relationships and serve as operational contact point with all contracting parties.
  • Maintain lines of communication with payer contracting staff throughout contract item.
  • Coordinate meetings with payers where the need is related to joint operations.
  • Work with VP and Senior Management to lead the departmental efforts for effective employer engagement in an effort to prepare NGHS for a future with potential employer direct contracting.
  • Oversee the additional of new facilities, new physicians and new services to managed care contracts.
  • Serve as a liaison between various NGHS departments and Managed Care Operations.
  • Oversee response to calls and emails from NGHS departments.
  • Improve overall Managed Care integration into the NGHS organization through communication.
  • Coordinate communication and education of physicians to ensure most accurate administration of contracts and efficient NGHS operations.
  • Coordinate communication and education of staff to ensure most accurate administration of contracts and efficient NGHS operations.
  • Oversee the development and monitoring of managed care contracts. Develop and evaluate reports regarding the managed care contract performance and payment variances.
  • Oversee managed care payment variance review function.
  • Manage and maintain annual schedule of terminations, renewals, escalators, etc.
  • Analyze payment variance reports/trends.
  • Coordinate activities related to contract rate development, modeling prediction, and other analyses as required to support NGHS Finance and Revenue Cycle.
  • Manage and coordinate Medical Economics department.
  • Act as the point of contact for Finance and Revenue Cycle concerning procedure pricing (CDM), contract rates and managed care contract performance.
  • Coordinate with report building for various departmental needs.
  • Coordinate with payer research relative to new technologies contemplated by NGHS.
  • Coordinate information gathering and feedback with industry experts on managed care market environment and NGHS relative market position.
Physical Demands
  • Weight Lifted: Up to 20 lbs, Frequently 31-65% of time
  • Weight Carried: Up to 20 lbs, Frequently 31-65% of time
  • Vision: Moderate, Frequently 31-65% of time
  • Kneeling/Stooping/Bending: Occasionally 0-30%
  • Standing/Walking: Occasionally 0-30%
  • Pushing/Pulling: Occasionally 0-30%
  • Intensity of Work: Occasionally 0-30%
  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding


About Northeast Georgia Health System, Inc.

Northeast Georgia Health System, Inc. (NGHS) is a non-profit healthcare system that serves the Northeast Georgia region. The system includes two hospitals, several urgent care centers, and a network of physicians and specialists. NGHS provides a wide range of medical services, including cancer care, heart and vascular care, neurology, orthopedics, and women's health. The system is committed to providing high-quality, patient-centered care and has been recognized for its clinical excellence and patient safety. NGHS is headquartered in Gainesville, Georgia and was founded in 1951.
Learn more about Northeast Georgia Health System, Inc.
Size
7,000 employees
Industry
Healthcare
Founded
1980
* Ladders Estimates

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