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Regional Director – Managed Care, Payor Relations
PAM Health. Ensure PAM Health and key facilities participate in managed care plan networks within their markets .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Managed Care Contracting, including negotiation and relationship management with payors, while effectively analyzing data to drive strategic initiatives and improve operational efficiencies. Possesses strong communication skills to facilitate collaboration across various healthcare operations and ensure compliance with industry regulations.
Highest-signal resume keywords
Managed Care ContractingPayor Relationship ManagementNegotiation SkillsData AnalysisHealthcare Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Managed CareContract NegotiationFinancial AnalysisHealthcare Reform KnowledgeReimbursement Strategies
Soft Skills
Effective CommunicationAttention to DetailEntrepreneurial Mindset
Tools & Technologies
Health Plan PortalsProvider PortalsCentral Billing Office Systems
Certifications & Qualifications
Managed Care Certifications
Industry Keywords
Managed MedicareManaged MedicaidACOBundled PaymentsGain Sharing ProgramsPublic PayorsTricareVA CCN ProgramsCMS
About the role
Key responsibilities & impact- Ensure PAM Health and key facilities participate in managed care plan networks within their markets
- Maintain and develop relationships with targeted payor sources
- Secure, maintain, renegotiate, evaluate, and negotiate payor contracts
- Develop managed care networks covering Managed Medicare, Managed Medicaid, Exchange Health Plans, ACOs, Bundled Payments, and Gain Sharing Programs
- Support PAM Health facilities, Corporate and Regional Operations, admissions, business offices, operations, case management, finance, and the Central Billing Office with contract-specific information
- Manage Managed Care contracting responsibilities for Voyages Behavioral Health psychiatric hospitals, including inpatient, outpatient, and Spravato Depression Outpatient programs
- Establish and manage local, regional, and national managed care relationships
- Identify and support contracting, education, and strategic initiatives, including Public Payors for psychiatric services
- Resolve escalated payor payment and systemic issues with the Central Billing Office
- Report Managed Care/Payor opportunities and threats, analytics, recommendations, and competitive transparency information to the SVP of Managed Care
- Identify districts and facilities needing contracts and secure agreements to increase utilization
- Coordinate with Regional Operations to increase Managed Care admissions under preferred compensation terms
- Support escalated insurance payor issues and trends to reduce days sales outstanding
- Develop and manage a disciplined contracting process aligned with business and financial objectives
- Oversee, manage, and negotiate assigned managed care agreements for IRF and LTACH facilities
- Provide leadership within the contracting team and manage priorities, standards, and work
- Develop relationships with payor decision-makers for contracting and referral management
- Analyze data to identify and solve managed care and payor contract or strategy problems
- Support centers with Letter of Agreement processes and negotiate rates
- Review contracts, complete Contract Summaries, and secure rate increases when warranted
- Translate Managed Care concepts into practice and advise on benefit issues, Health Plan updates, Provider Portal issues, Tricare, and VA CCN programs
- Facilitate Health Plan contacts to support Central Billing Office collection efforts
- Monitor Transparency regulations and Provider Directory requirements
- Identify opportunities to contract additional PAM Health facilities and expand health plan relationships
- Identify and share Managed Care Scorecards and advise facilities on improvement opportunities
- Perform other business-related duties as assigned
Requirements
What you’ll need- College degree preferred
- 5 years plus experience in either a Network Role within a Managed Care Health Plan or Public Payor Program, or Provider Experience in a Managed Care Contracting Role
- Managed Care Certifications are a plus
- Attention to financial details
- Effective written communication skills
- Effective communication skills
- Entrepreneurial mindset to grow organizational revenues and identify opportunities that increase company margins
- Knowledge of managed care, product information, contract requirements, Health Plan Portals, policy requirements impacting billing and operations, payor strategy, Health Exchanges, Provider Portals, Tricare, VA CCN programs, CMS, reimbursement, and healthcare reform issues
Benefits
Comp & perks- Competitive pay
- Generous paid benefit time
- Excellent insurance options
- Professional growth opportunities through the Education Advancement Program
- Collaborative environment with colleagues and leadership
- Exposure to a variety of patient care levels
- We Care Program