[Hiring] Managed Care Regional Director @CSI Companies

Role Description

The Managed Care Regional Director will be responsible for evaluating, negotiating, credentialing, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations.

• Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
• Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle.
• Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payers and providers.
• Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations.
• Responsible for coordination and communication between managed care and other interested party departments and leadership.
• Responsible for developing new and existing relationships with medical and pharmacy plans to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations.
• Oversight of payer credentialing.
• Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting.
• Communicates with respective payers related to trends and compliance with contract parameters.
• Consistently represents the company in a professional manner.
• Maintain effective working relationships and cooperate with all personnel in the Company.
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies.
• Perform other duties and responsibilities as assigned.

Qualifications

• Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contracts.
• Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possible.
• Must possess the ability to multi-task and frequently change direction.

Requirements

• Bachelor’s Degree preferred or equivalent experience.
• At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry.
• Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience.
• Preferred experience in managing, analyzing, and reporting denials and appeals.

Physical Demands

• Regularly required to talk or listen.
• Regularly required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• Frequently lifts and/or moves up to 20 pounds.
• Specific vision abilities required include close vision and the ability to adjust focus.

Work Environment

• Generally operates in a clerical office setting.
• Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
• May travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE

Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

CSI Pharmacy is an Equal Opportunity Employer.