[Hiring] Director of Managed Care @Fresenius Medical Care

Role Description

Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc). Oversees Division's contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments. Develops and directs regional marketing efforts to third party payors in order to support growth and profitability in the region.

Principal Duties and Responsibilities

• Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
• Reviews and analyzes potential contracts for financial effect, cost benefit and utilization.
• Negotiates contractual relationships with managed care organizations and other third party payors as needed.
• Presents contract proposals and market and industry analyses to internal parties and responds to Requests for Proposals from third party payors.
• Manages activities concerned with contracts for delivery systems.
• Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.
• Interprets company-wide policies and procedures.
• Ensures compliance of facilities with all managed care organization requirements and ensures credentialing processes are implemented.
• Develops and implements methods and procedures for monitoring work activities and informs management of current work activity status.
• Responsible for continuous communication and coordination of all required ongoing documentation with appropriate staff.
• Works with internal and external counsel as needed to resolve issues and support FMS.
• Negotiates and implements contracts with payors that require clinical and quality outcomes measurements.
• Contributes to the design and implementation of third party payor compensation structures.
• Assists in the development of report cards that can be shared with third party payors illustrating outstanding quality of patient care through associated outcomes.
• Assists with designing Quality Improvement Projects that will improve outcomes in facilities that are not meeting goals.
• Develops and implements regional marketing plans to support regional growth and profitability and marketing of FMS services to third party payors and potential referral sources.
• Maintains knowledge of FMCNA products, services and strategies in order to market appropriately.
• Maintains current knowledge regarding community healthcare market and industry issues that may impact the business.
• Generally manages department budget and day-to-day functions.
• Responsible for implementation and achievement of business plan, budget, key performance indicators and communication to appropriate executives.
• Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution.
• Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.
• Provides technical guidance.
• Assists with various projects as assigned.
• Other duties as assigned.

Physical Demands and Working Conditions

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervision

May be responsible for the direct supervision of various levels of managed care and marketing staff.

Education

• Bachelor's Degree in Business or Health management required; Advanced Degree desirable.

Experience and Required Skills

• 6 - 8 years' direct experience in contract negotiation and operational experience in a multiple site outpatient facility setting including profit and loss responsibility.
• 3+ years' experience as a Manager preferred.
• Demonstrated ability to manage one or more departments.
• Ability to manage databases and provide analysis.
• Proficient with PCs, Microsoft Office applications and business computer systems.
• Strong oral and written communication skills.