Director, Managed Care

General Responsibilities  

The Director of Managed Care is responsible for the negotiation, implementation and payer relations of physician and ancillary managed care contracts, and is the primary point person  for RHMS and their ancillary CBO's in the mid-Atlantic region of Trinity Health under the direction of the Senior Director Managed Care.  The Director shall have primary responsibilities for physician and ancillary managed care payer negotiations, implementation and management on behalf of his/her assigned RHMs, including development and implementation of strategies, goals, and objectives for successful completion of negotiations, identification and tracking of critical contract and renewal dates.  The Director shall serve as the lead negotiator with payers as assigned, shall serve as the lead liaison to RHMs and payers as assigned, shall proactively identify revenue recovery and other operational/strategic opportunities, shall promote enhanced use of Meditract by supported RHMs, shall ensure RHMs and payers comply with contract provisions, via tracking of performance through a variety of means, including audit of current performance via claims review, reports, etc.  The Director will work in close coordination with RHM senior management and operating unit departments and support areas such as Patient Access, Central Billing Offices, and medical management areas to improve functions across departments and with payers.  The Director shall provide training and tools for use by the RHMs and their staff regarding key manage care contract provisions, market trends, and opportunities for improvement in support of RHM goals/objectives, and consistent with the mission and values of Mercy Health System/Trinity Health.

Basic Qualifications

Education and Training: Bachelor's degree, Master's Degree preferred

Certification and Licensure 

Skills: Proficiency in Microsoft Office including advanced skills in Excel
Successful track record in managed care contracting negotiations
Excellent verbal and written communications skills

Experience: Minimum 7-10 years of successful managed care hospital negotiation or related experience. 
Extensive knowledge of hospital decision support systems, payer mechanisms and cost accounting