We are recruiting for a Director, Managed Care Relationships to join our Managed Care Department in Southern California.This position requires residency in Southern California.
An experienced Managed Care executive to lead development and execution of the Managed Care strategy, including all managed care related payor relations initiatives for assigned markets, including the Southern California Market. This individual will serve as a key market leader and critical liaison between the market's managed care payers and Kindred Hospital Division operations and other support services (Case Management, Sales and Marketing, Business Office, etc.). Collaborates with market colleagues to identify and execute on business development, revenue growth opportunities, systematic clinical and/or operational issues with managed care or 3 rd party payors. This position is both internal and external facing, develops and maintains effective working relationships with key stakeholders with managed care payers in the market. Executes on business development opportunities by focusing on Kindred's value proposition and drives increased managed care penetration across the Kindred's continuum of care.
Essential Functions (as applicable based on market and number of direct reports):
Develops and updates the local Market Managed Care Strategy in collaboration with Operations leadership, the regional VP, Managed Care and other market colleagues, including documentation of goals, activities, and progress achieved
In collaboration with the regional VP and Managed Care, determines the optimal allocation of necessary resources to effectively manage the relationships with payers/IPAs/medical groups in the market, including provider organizations under a contractual or risk-bearing agreement
Self-directed to build and maintain s managed care payer relationships in support of the Managed Care strategy for each market to ensure (i) appropriate contact and communication at all necessary levels within the payor organization (e.g. contracting, medical management, discharge planning, etc.), (ii) communication of Kindred's value proposition (iii) resolving "barriers to entry", and (iv) consistency of messaging in general
Owns and manages all aspects of assigned portfolio of managed care and associated payor relationships, including (i) identifying opportunities to grow our managed care business and scheduling meetings with the relevant payer contacts, (ii) creating tailored presentations / materials, (iii) soliciting preparation/data collection, analysis, and attendance support from appropriate internal colleagues, as necessary, and (iv) leading productive payor meetings
Sponsors and holds quarterly Joint Operating/Quality Committee (JOC/JQC) meetings with managed care payer leadership and key decision-makers to identify and pursue business growth opportunities, resolve key clinical and/or operational issues, etc.
Sponsors quarterly cross-divisional, cross-functional Managed Care meetings (a forum for communication between the market's key internal constituents) to assess key managed care trends, and to inform and adjust market-based managed care strategies and contract initiatives, as necessary
Educates and trains core group of market operators and other internal support services (e.g. Business Office, Admission, Sales & Marketing, Medical Management, etc.) on relevant elements of new or renegotiated contracts
Updates and maintains payor-specific activity for assigned accounts
Documents critical reporting capabilities for Kindred based on payors' evolving data needs, as identified in JOC/JQC and other meetings
Manages local and attends national conferences, as relevant
Attends relevant regional, division, district, and departmental staff meetings
Works collaboratively with key internal constituents (e.g. Operations leadership, CFOs, other managed care team members, etc.) to establish optimal Managed Care strategy, and ensure compliance and & successful implementation
Directly negotiates single case agreements with acceptable managed care payors that enables assigned markets to meet their performance objectives
Maintains integrity of managed care information, including Managed Care databases, contract rate dissemination and education in concert with Sr Dir Managed Care
Monitors and keeps current on Federal/State laws and regulations as they apply to health benefit contracts
Tracks and monitors all contract activity for assigned market area
Builds consensus with Market Executive Directors/CFO and Sr Dir Managed Care on Managed Care goals, objectives, strategies, individual contract terms, etc.
Self-motivated and results oriented
Strategic thinker and takes initiative to seek out solutions
Strong organizational and interpersonal skills, including the ability to work collaboratively in a matrix environment and with various colleagues at all levels of the organization to achieve defined market-specific goals; High degree of comfort interacting with Medical Directors and Senior Utilization Management team in Managed Care organizations
Comprehensive understanding of industry standard managed contract language and the impact on various aspects of our business and healthcare stakeholders (i.e. Health Plans, Hospitals, IPAs, MSOs, etc.)
Ability to effectively communicate in English in verbal, written, and presentation form
Demonstrated analytical abilities and proficient planning skills and negotiation skills
Ability to work under stress and meet deadlines
Ability to travel occasionally; approximate percent of time required to travel: 10%
Bachelor's degree in business or related field.
Master's degree and/or Bachelor of Science/Associate degree in nursing preferred.
7-10 years healthcare experience in the areas of managed care contracting, payer/provider relations, and/or business development.
Knowledge of the Post-Acute industry preferred.
Depending on candidate's qualification, we may fill this at a different level.