CharlotteRecruiter Since 2001
the smart solution for Charlotte jobs

Director Managed Care Contract Modeling

Company: Job Juncture
Location: Charlotte
Posted on: August 17, 2019

Job Description:

Work for a major health system in a visible position leading managed care contract modeling and analytics in relation to negotiations with insurance payors.

Job Summary

Develops and maintains analytical tools, manages and trains staff, and uses data to provide recommendations on reimbursement methodology and rates for managed care contracts. Prepares financial analyses of current state, models the financial impact of potential reimbursement methods and rates, and determines the optimum structure and rates for proposals during negotiations with managed care organizations. Systematically plans and executes medium and long range activities to prepare for future contracting events. Responds to extremely urgent, mission-critical projects driven by contracting opportunities or issues. Responsibilities span all System owned, leased or managed entities.

Essential Functions

---Directs a team of professionals to meet the objectives of the department, division and System including providing accurate and timely information, and creating sophisticated, valid models for managed care financial terms, and improving operational and financial results.

---Manages multiple, complex projects using all available resources, while exercising good judgment toward meeting goals and objectives.

---Understands and complies with HIPAA requirements for PHI security and disclosure.

---Maintains knowledge of trends and developments in the field via journals and related materials, attending seminars, conferences and vendor training sessions.

---Ensures that staff regularly reviews performance of managed care portfolio and contracted payers using budgeted and modeled performance as benchmarks and highlighting performance issues or problems with key stakeholders.

---Focuses on employee development by coaching and educating in areas including data integrity, reimbursement, coding/DRGs, Managed Care, Payment Reform, margins and other healthcare operations.

---Ensures that staff maintains detailed documentation of modeling criteria and results from modeling and analyses including making recommendations as needed during active negotiations.

---Maintains documentation of policies and procedures and manages departmental decisions and responses to priorities.

---Reviews and documents completed reports/projects and establishes review and QA processes to ensure accuracy in modeling and analysis.

---Leads team to develop and maintain fee schedules and rate documents, provide analysis of proposals, make recommendations for optimum rate structures and terms, and communicate current rates/fees to internal customers.

---Collaborates with infrastructure teams to determine appropriate data sources and data needed to support managed care analytics.

Education and Experience:

Bachelors Degree required, Advanced degree, MBA or MHA preferred. Five to ten years of experience working with Contract Modeling and Analysis with a large multi-Hospital system or Payor.

Keywords: Job Juncture, Charlotte , Director Managed Care Contract Modeling, Executive , Charlotte, North Carolina

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Real Estate Office Transaction Manager
Description: Very busy real estate office seeking experienced Realtor NC and SC license preferred to assume the role of Office Manager and Transaction Coordinator.-- br br You will be wearing multiple hats and (more...)
Company: Showcase Realty, LLC
Location: Charlotte
Posted on: 08/24/2019

Production Operations Manager
Description: Where good people build rewarding careers.Think that working in the insurance field can't be exciting, rewarding and challenging Think again. You'll help us reinvent protection and retirement to improve (more...)
Company: Allstate
Location: Charlotte
Posted on: 08/24/2019

Data/Information Modeler, Manager
Description: Where good people build rewarding careers.Think that working in the insurance field can't be exciting, rewarding and challenging Think again. You'll help us reinvent protection and retirement to improve (more...)
Company: Allstate
Location: Charlotte
Posted on: 08/24/2019


IT Service Account Manager
Description: OverviewThe IT Service Account Manager acts as the primary contact between Schaefer and the customers they are assigned to. The IT Service Account Manager is responsible for the overall satisfaction of (more...)
Company: Schaefer Systems
Location: Charlotte
Posted on: 08/24/2019

Project Manager
Description: Project Manager br If you are a Project Manager with experience, please read on br br br What You Will Be Doing br - Provide roadway design and project assistance to the transportation design (more...)
Company: CyberCoders
Location: Charlotte
Posted on: 08/24/2019

Lead Program Manager, Compliance
Description: Logistics done differently. br br At XPO Logistics, we believe that a motivated and engaged workforce is critical to our success. We're looking for a hardworking, highly skilled professional who knows (more...)
Company: XPO Logistics
Location: Charlotte
Posted on: 08/24/2019

Brand Sales Manager
Description: Brand Sales Manager At our Company, we grow People, Brands, and Businesses We are seeking a dynamic Brand Sales Manager to be responsible for managing major sales programs and strategic planning initiatives (more...)
Company: Advantage Solutions
Location: Charlotte
Posted on: 08/24/2019

Application Manager
Description: Job Description Job : 995942 A major Banking Institution in Charlotte, North Carolina has an opening for an Application Manager. Please see further description below: br br Application Manager (more...)
Company: Apex Systems, Inc
Location: Charlotte
Posted on: 08/24/2019

Global Security & Controls Manager
Description: Summary The Global SAP Security and Controls Manager is a key member of the team responsible for the design, deployment, and ongoing support of the Global JELD-WEN SAP Enterprise Resource Planning solution. (more...)
Company: JELD-WEN, Inc. Windows and Doors
Location: Charlotte
Posted on: 08/24/2019

Executive VP of Business Development - Own a Franchise
Description: Executive VP of Business Development:
Company: CMP.jobs
Location: Charlotte
Posted on: 08/24/2019

Log In or Create An Account

Get the latest North Carolina jobs by following @recnetNC on Twitter!

Charlotte RSS job feeds