Description
We are seeking a Managed Care VP for leading an outpatient opioid treatment center locatd in central Florida.
Our client is a leading provider of specialized quality care for Opioid Use Disorder (OUD), operating since 1986 with more than 80 addiction treatment centers in 20 states nationwide. They support the education and understanding of opioid addiction as a disease so that communities will support those affected by the disease to seek the help they need.
Hybrid
3 days on site 2 days remote
Salary Range
140 to 175k and up to 25% performance bonus
All positions offer a competitive salary
Full-time positions include a comprehensive benefits package
Strong relocation assistance for the right candidate.
Sign-on bonus opportunities in some locations
Number of Direct report # 7
This Healthcare is a leading provider of quality care, successfully treating opioid dependence for more than 30 years. They use proven methods, the most innovative techniques and an approach that focuses on the patient’s whole well-being. Services are comprehensive and include: a range of counseling options, medication-assisted treatment, and medical exams. Each clinic team is devoted to rebuilding lives, positively impacting patients and the communities where they serve.
Job Summary:
This position is responsible for maintaining contractual relationships with payers and health plans. Facilitates payer contracting activities, including contract review, negotiation of terms, strategic positioning, provider enrollment, dispute resolution and growth opportunities. Responsible for the maintenance of managed care plan operating policies and systems; developing effective relationships with payers and providers related to those managed care plans; coordinating the analysis, reporting and negotiation of payer contracts. This position also oversees the charge data master (CDM) and practice management database where provider, location and group information is stored for business purposes.
Essential Functions:
- Establishes and maintains relationships with third party payors, educating them on the dynamics of Medication Assisted Treatment (MAT).
- Manages contract renewals, revalidations, and renegotiations as required; creates and maintains a contract tracking database to ensure contracts are reviewed and renewed on a timely basis.
- Responsible as primary lead for organization in communications to payers for contract negotiations
- Monitors, analyzes and reports on the state of the payer industry via report cards and other assessments.
- Assists with the negotiation and monitoring of contract performance of value-based contracts with payers, including the success of meeting financial and quality targets.
- Identifies opportunities to serve members in a particular market due to a health plan presence where a contractual opportunity exists.
- Manages contract enrollment and works with Credentialing team to manage credentialing and recredentialing activities.
- Oversees the establishment of contractual relationships and announces the rollout of a new health plan as well as reporting interim activity.
- Works with the Audit & Analyst Team to assess and respond to payment proposals and to develop modeling analysis tools.
- Partners with Revenue Cycle Operations and other leadership disciplines to establish guidelines, policies and protocols regarding payor/provider interactions.
- Collaborates with the Senior Vice President of Revenue Management in the resolution of escalated issues with payors.
- Develop indicators for monitoring and evaluating quality of work and meeting turnaround time standards.
- Establishes work directions, resolves problems, and sets performance expectations and deadlines to ensure timely completion of all department deliverables.
- Participates in / manages special projects as requested/required.
Essential Qualifications:
Education/Licensure/Certification:
This position requires a bachelor’s degree in business or related
Strong Direct Managed Care
Required Knowledge:
The ideal candidate will have strong oral and written communication and relationship building skills. Also, knowledge
of the contracting process; knowledge of major U.S managed care and non-managed care health insurers.
Experience Required: The ideal candidate will have a minimum of 5 years of third-party healthcare insurance contracting experience,
including contract renegotiation. Experience with behavioral healthcare organization preferred. Thorough knowledge of the experience with healthcare regulatory environment, and strong industry relationships with managed care/non-managed care third party payors.