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Director - Managed Care - Payer Contracting & Alignment

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Asheville, NC, United States

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Overview

Mission Health located in Asheville, NC is accepting applications for a Director - Payer Contracting & Alignment (PCA)

 

JOB SUMMARY :

Administer and coordinate on behalf of HCA Physician Services in their respective Division or Market, all managed care contract negotiation, analysis and compliance activities in support of the managed care strategies, business and financial plans.

 

SUPPORTS HCA BY:

  • Provide managed care support and expertise by attending scheduled meetings with operations leadership, including Division/Market/Practice operations management
  • Develop and implement, in conjunction with the Service Center an annual operating plan and managed care strategic plan
  • Coordinate and administer managed care contract negotiation process for designated Division/Market/Practice Management
  • Oversee individual practice managed care contracting efforts
  • Analyze and estimate financial impact of managed care contracts as requested by operations management for Division/Market/Practice
  • Coordinate significant managed care analysis and activities with PHO/IPA operators and managed care operations management as appropriate
  • Oversee respective service center managed care compliance efforts
  • Maintain permanent record of all major payer contracts for respective service center market
  • Administer protocols to ensure smooth and timely implementation of contract terms
  • Prepare monthly reports to summarize managed care negotiation activities in the Division /Market/Practice.
  • Analyze performance and provide evaluation on all existing contracts to operations management annually and/or as requested
  • Design and direct Market projects as requested by leadership
  • Administer company’s guidelines for managed care contracting and compliance
  • Maintain knowledge of state and federal legislative and regulatory laws and rules regarding managed care
  • Market Managed Care Product line
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Perform other duties as assigned by supervisor

 

Education: College Graduate Preferred

 

Experience: 7+ Years of relevant experience required

 

Preferred Experience in managed care, preferably with prior experience in contract analysis and negotiations. Business office experience preferred.

 

ABOUT MISSION HEALTH

Mission Health, an operating division of HCA Healthcare, is based in Asheville, North Carolina and is the state’s sixth largest health system. In 2018, for the sixth time in the past seven years, Mission Health has been named one of the nation’s Top 15 Health Systems by IBM Watson Health (formerly Truven Health Analytics). Mission Health is the only health system in North Carolina to achieve this recognition. Mission Health operates six hospitals, numerous outpatient and surgery centers, post-acute care provider CarePartners, long-term acute care provider Asheville Specialty Hospital, and the region’s only dedicated Level II trauma center. With approximately 12,000 colleagues and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina. For more information, please visit missionhealth.org or @MissionHealthNC.

 

Mission Health is an Equal Opportunity Employer, and as such offers equal employment opportunities to applicants and employees without regard to race, color, religion, national origin, age, disability, gender, gender identity, sexual orientation, genetic information, protected veteran status or any other protected characteristic.

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Facility: North Carolina Division
Job ID: 47065
Category: Executive
Contract: Regular Full-Time
Shift: 8am - 5pm, varying
Job Class: Regular Full-Time

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