Director Managed Care

Summary

Williamson Medical Center is hiring a Director of Managed Care in Franklin, TN.  This is a full time position on day shift.  This position is eligible for an excellent benefit package offering medical, dental, vision, paid time off, generous retirement matching, flexible spending accounts, voluntary life, short-term disability and long-term disability, discounted membership to Williamson County Recreation Centers and more!
At Williamson Medical Center, our employees are more than just another number. To us, they’re family. They’re smart, talented, compassionate, dedicated, and an overall joy to be around. We’re certainly blessed to have the best of the best working here from the cafeteria to the operating room.
But as Williamson County and surrounding areas continue to grow, so must we. That’s why we want YOU to join our family!

Williamson Medical Center is an equal-opportunity employer and a drug-free workplace.

Position Summary:
The Director of Managed Care will lead the contracting and managed care strategies for Williamson Medical Center and its affiliate organizations. Reporting to the Chief Financial Officer, the Director of Managed Care will be responsible for the negotiation, implementation, monitoring and evaluation of the hospital and ancillary managed care payer contractual arrangements. This position will make an immediate impact on several short and long term payer strategies that position Williamson Medical Center for collaboration, growth and delivering on a value equation that meets the needs of the communities served.
The successful candidate must have a Bachelor’s degree. Additionally, candidates must have an outstanding record of achievement in negotiating competitive contract rates utilizing innovative contracting methodologies. Candidates should have payer contracting and contract modeling experience in a hospital/health system environment.  Experience negotiating physician rates preferred.  Payer experience is helpful.

Position Requirements:
Formal Education / Training:
Bachelor’s degree required.  

Workplace Experience:
Extensive knowledge of health insurance required, including previous experience in dealing with health insurance contracting.  Knowledge of and experience with hospital operations preferred.  Computer skills, in multiple applications, and excellent communication skills are necessary.

Equipment and Skills Training:
Computer proficiency in applications such as Excel, Word are necessary.   Skills should be representative of those required to operate in a professional environment.  

Physical Environment and Availability:
Medical Center/Hospital
Employee must be reasonably accessible outside work hours by mobile phone and inform employer of mobile telephone number.  Employer does not furnish or reimburse for a mobile or smart phone for this position.

Physical Effort:
Requires sitting for extended periods of time, and using repetitive motion skills

Key Results:
Create managed care strategy consistent with strategic plan for the health system
Actively manage contract portfolio, including negotiating new and existing contracts.  Also works to identify and resolve payer issues.
Negotiate competitive contract terms.  Reviews industry market rates and data to insure the health system rates are/remain in a market competitive position 
Maintain positive payer relations.  Regularly meets with payers in person or by phone to develop relationships and assist in resolving payer issues.
Coordinate and validate contract modeling and payer payment vs. expected reimbursement reviews.
Prepare proformas regarding managed care agreements.  Assist in the budgeting process by providing information about new contracts and their expected performance to Finance.
Direct activities related to value based purchasing and quality initiatives
Ensure payer compliance with contract terms
Prepare payer scorecards and review with payers quarterly.