Associate Director Managed Care, Duke University Health System, Durham, North Carolina

Description:

Has primary responsibility for identifying prospective managed care contracts, negotiation, and rate determination for the Duke University Health System, Inc. (includes 3 hospitals, 2 ambulatory surgery centers, 2 retail pharmacies, 90+ employed physician group, home health, home infusion, and hospice). Oversees the data collection function for both prospective contracts and current contracts and assists in the analysis of that data. Initiates the renewal process as appropriate. Performs these functions in accordance with established policy and procedure. Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts. 

Duties and Responsibilities:

Responsible for the development and management of negotiations for managed care contracts in a manner consistent with the Health System’s strategic approach to managed care, including:

• Evaluation of new contracting opportunities, including substantive and pricing components, for the Health System.
• Management of financial, operational, and legal analysis of proposed managed care agreements.
• Serve as the primary negotiator in managed care negotiations. Negotiates contract rates and provisions in accordance with established Health System policy and procedure.
• Assist in the organization of site visits for payers, third party administrators, as required.
• Assist in the development of the necessary systems to support the data and analysis needs of managed care contracting.
• Responsible for assisting in the implementation of managed care contracts, including:
  • Coordinate with Patient Revenue Management Organization the contract implementation process for appropriate internal audiences, including hospital and professional administrative and professional staffs.
  • Identify and recommend appropriate changes in operating procedures and systems that might be required to accommodate a managed care contract.
  • Assist in the scheduling and facilitating of orientations/workshops with payers/third party administrators for Health System personnel.
  • Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts.
• Responsible for monitoring the performance of managed care agreements, including:
  • Development and maintenance of quarterly management reports for Health System senior management analyzing managed care activities, contract trends, costs and profitability.
  • Monitor managed care companies’ compliance with contractual requirements of the managed care agreements. Responds quickly and effectively to negative trends.
  • Evaluate existing agreements and report findings/recommendations to renegotiate/modify/terminate contractual relationships to Assistant Vice President, Managed Care.
  • Meet with plan representatives to discuss ways to strengthen existing relations.
• Responsible for assisting the Assistant Vice President, Managed Care in developing the strategic managed care plan for the Health System, including:
  • Serve as a liaison to Health System’s Clinical Service Unit managers in the strategic planning process.
  • Interact with all Health System components in the development and implementation of managed care initiatives.
• Responsible for representing the Health System to external audiences at conferences, presentations, workshops, association meetings, community events, etc., including:
  • Represent the Health System to managed care entities in day-to-day customer service relations.
  • Performs other assigned responsibilities and projects as delegated by the Assistant Vice President, Managed Care.

Develops and implements a personal development program to ensure continuing professional growth.

Minumum Qualifications:

Required Qualifications at this Level:

Education:

Bachelor’s degree in Business Administration, Health Care Management or related field. MBA and/or MHA highly desirable

Experience:

A minimum 5 years of hospital, physician and alternate site managed care contracting experience for commercial, Medicare, and Medicaid. Minimum 2 years of experience with solid organ and bone marrow transplant contracting preferred.

Knowledge, Skills, and Abilities:

Excellent direct negotiation, analytical, verbal and written communication skills. Ability to prioritize, works well independently, and handles multiple projects simultaneously. Direct experience with financial analysis and contract analysis highly desirable. Must be knowledgeable regarding health care, managed care concepts, third party payer contract terms and legal issues, financial analysis, and the medical reimbursement environment. The position must be able to facilitate and problem solve at multiple levels within the organization. The position must be able to appropriately represent the organization to external audiences. Must stay abreast of managed care developments through professional associations, trade publications, and consumer groups. Experience with IBM-PC software packages (Lotus Notes, Word, Excel, and Access).

Contact:

Web link: https://www.hr.duke.edu/secure/jobs/external.html.

Requisition Number: 400246367