Director, Managed Care Contracting
Reporting to the Vice President of Managed Care and Credentialing in the Inova Systems Office, located in Falls Church, Virginia, the Director of Managed Care Contracting is part of the team that is responsible for negotiating payer agreements that will advance Inova Health System and continue the transition from fee-for-service models of payment towards value-based reimbursement methodologies, including incentive structures, narrow networks, gain share, bundling and capitated arrangements. The incumbent will participate in the development, negotiation, implementation, monitoring and management of all assigned third party payor contracts. Contracted services covered include acute care hospitals, ambulatory surgery facilities, radiology centers, urgent care centers, free-standing emergency departments, full-service outpatient sites (HealthPlexes) reference laboratories and physician practice sites. Incumbent will develop and maintain a network of relationships with third party payors. Incumbent will establish and maintain effective relationships with Inova facility and system operational management, as well as Inova Patient Financial Services.
- Develop the strategy, objectives, techniques and tactics to achieve the strategic goals of the department
- Through decision support and analysis, support health plan, network and managed care contract strategy, development, operations, and analysis of performance
- Develop financial and market analysis in preparation for negotiations
- Draft, review and negotiate all Payer contracts, including ones flexible enough to respond to an ever changing market over multi-year agreements
- Develop contract implementation tools and lead installation meetings to support the smooth operation and administration of contracts
- Monitor and report contract performance on a routine and ongoing basis
- Manage large appeals and negotiate settlements
- Develop effective working relationships with finance, legal, hospital leadership, clinical department leadership
- Provide Managed Care and contracting guidance and expertise to other areas of the organization
- Recognize revenue opportunities and develop a strategy to incorporate them into existing and future contracts
- Develop the strategy to incorporate the delivery and reimbursement for new technologies into existing and future contracts
- Predict and drive change in an increasingly competitive market and in Payer contractual relationships that better position the organization, financially and competitively
- Keep abreast of financial and managed care regulations impacting the market and the organization
- Negotiate rates and terms for single case agreements with plans with which Inova does not participate
- Participate in the managed care revenue forecasting process
- Prepare routine and ad hoc reporting on area managed care market specifically and the state of the managed care industry generally
- Serve on various Inova committees and task forces
- At least 5-7 years’ experience in a managed care environment with significant knowledge of health plan operations and hospital, ancillary and physician contracting.
- Extensive and comprehensive knowledge of the payer and provider market, both regional and national.
- Minimum requirement is a Bachelor’s Degree and Master’s Degree is Preferred.
- Demonstrated history of successful negotiations with large national and regional Payers.
- Comprehensive financial analysis, business planning, contract development and negotiation skills.
- Significant experience with health plan/health care operating systems.
- Demonstrated knowledge of current trends in health insurance and the managed care marketplace.
- Must possess strong financial acumen and a comprehensive understanding of contractual options, healthcare economics and competitors’ practices.
- Broad and deep understanding of healthcare reimbursement methodologies is required.
- Proactive, strategic thinker
- Excellent interpersonal skills, and interacting and corresponding with internal and external executives
- Excellent English verbal and written communication skills
- Strong management skills