Dignity Health

Director of Managed Care

Job ID
2017-36809
Employment Type
Full Time
Department
Managed Care Contracting
Hours / Pay Period
80
Facility
Mercy Healthcare Sacramento
Shift
Day
Location
RANCHO CORDOVA
CA
Standard Hours
varies

Overview

Dignity Health, one of the nation’s largest health care systems, is a 21-state network of 9,000 physicians, 59,000 employees, and more than 400 care centers, including hospitals, urgent and occupational care, imaging centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved.  In FY15, Dignity Health provided $1.7 billion in charitable care and services. For more information, please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

Responsibilities

Position Summary:

 

Responsible for contributing to strategic planning; strategy implementation; maintaining and developing relationships internally and with health plans; leading, organizing, directing and conducting negotiations; and implementation of managed care agreements with current and prospective purchasers or providers of healthcare services on behalf of Dignity Health. The contracts include such payer entities as HMO's, PPO's, EPO's, Workers Compensation carriers and MediCal. By securing optimal reimbursement and protecting the interests of the hospitals in contract negotiations and the implementation and management of managed care contracts and relationships, this position is essential to Dignity Health and individual hospital's financial performance.

 

Core Duties:

  • Negotiates contracts with existing payers (health plans and physician organizations) based on prior contract performance, future potential and current strategic and financial goals.
  • Develops and enhances relationships with internal and external contacts. Proactively plan, prioritize, and communicate regarding projects, issues, and negotiations to ensure relationships are maintained and DIGNITY HEALTH's values are demonstrated on a day-day basis and when difficult business decisions need to be made.
  • Leads and coordinates activities of personnel in the analysis, negotiation, and management of existing managed care contracts. This includes the maintenance of a variety of activity reports in support of financial reporting as related to managed care contract performance.
  • Coordinates implementation of HMO, PPO, and other managed care contracts with Patient Financial Services, Admitting, and Case Management; develop and maintain systems and procedures to disseminate pertinent contract information in a timely manner to appropriate regional and hospital personnel.

Qualifications

Minimum Qualifications:

  • Bachelor degree (or equivalent experiece and accomplishments) required
  • Seven (7) years of experience with progressive responsibility in a healthcare environment, of which five (5) years are in a significant management capacity withinn Managed Care Contracting for a large hospital, hospital system or health plan, required
  • Requires:

    • Knowledge of the methods and techniques used for skill and career development; ability to use these to deepen own expertise and coach, mentor and challenge others both inside and outside the organization.
    • Knowledge of successful negotiation concepts and techniques; ability to negotiate successfully across the organization and with external vendors and clients in a constructive and collaborative manner.
    • Knowledge of the organization's industry group, trends, directions, major issues, regulatory considerations, and trendsetters; ability to apply this knowledge appropriately to diverse situations.
    • Knowledge of health insurance products, market segments and marketplaces; ability to apply this knowledge to meet specific business goals and objectives.
    • Knowledge of and ability to read, interpret and draw accurate conclusions from financial and numerical material.
    • Knowledge of and ability to use the proper processes and practices for managing and administering a variety of contractual agreements.

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