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J178064

Director Managed Care

Allegheny Health Network

  • Company AHN
  • Pittsburgh, PA
  • Legal
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

Responsible for System-wide leadership and management of 3rd party payer contracting. Development and implementation of the managed care and payor relations strategies. Is the principal negotiator of for WPAHS and the principle contact for all payors. Is the point-of-contact and principal resource for the external and internal customers in order to manage the implementation, servicing, and compliance with payer contracts. Responsible for developing pricing strategies and for developing contract language. Finalizes all WPAHS payer contracts. Directs all Managed Care goals, objectives, and analyses of payer contract performance, related metrics and financial information to meet the requirements of the organization.

ESSENTIAL RESPONSIBILITIES:

  • Develops and implements the Managed Care Department's strategic plan and daily operating processes. 35%
  • Provides executive leadership and managerial direction in the development, implementation, coordination, and administration of the services provided by the Managed Care Department in order to achieve specific goals and objectives. Performs all steps necessary relative to hiring, evaluating, coaching, promoting, disciplining & discharging employees by following established HR policies. 25%
  • Negotiates multi-million dollar contracts and assures equity with the marketplace through strategic evaluation of competitors, developing and building relationships with the major health plans, and development of contract models that are in keeping with current state and, or, federal healthcare reform, and quality initiatives, as well as health plan and government regulations and guidelines. 20%
  • Works closely with hospital administrative teams to create, enhance & implement managed care strategies that meet the operational needs of the organization. 10%
  • Implements necessary controls and procedures to ensure data integrity and revenue cycle synergies across departments including Managed Care, Patient Financial Services, Care Management, Accounting and Decision Support. 10%

MINIMUM QUALIFICATIONS:

  • Bachelors in Accounting, Information Systems, Finance, or Healthcare Administration
  • 6 years of progressive payor contract negotiations in a large provider system setting or large payer environment. 6 years’ experience with provider/payor relations with at least 3 years of leadership/management experience.

Preferred

  • Master's degree preferred.

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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