CSI Pharmacy, LLC
At CSI Pharmacy (CSI) , we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care.
CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission. Summary
The
Director of
Managed Care
will
be responsible for
evaluating, negotiating
,
credentialing, and
securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. Salary Range : $150,000 - $180,000 (DOE) Schedule :
(Remote) Monday - Friday, 8:30am - 5:00pm Location : California Travel : This position is expected to travel up to 25 - 30% for various conferences, sales meetings, etc. with the longest being 4 weekdays at a time Essential Duties and Responsibilities
includ
e
the following. Other duties may be
assigned,
as necessary. Leads the implementation process of managed care contracts and develops and
maintain
systems to
disseminate
contract information
Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
Achieve and
maintain
a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers
Responsible for all aspects of managed car
e
and direct revenue contract management including analysis interpretation, implementation, maintenance of the
contract’s
performance, and payer relations
Responsible for coordination and communication between managed care and other
interested party
departments and leadership
Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
Oversight of payer credentialing
Will
assist
with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
Communicates with respective payers related to trends and compliance with contract parameters
Consistently
represent
s
the company in a professional manner
Maintain effective working relationship and cooperate with all personnel in the Company
Adheres to the
Company’s compliance requirements
as
stated
in the policy and procedure manual and all other related
policies
Perform other duties and responsibilities as assigned
Qualification Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability
required
. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Establish and
maintain
a system of reviewing and assessing changes in the Federal and or State regulations
regarding
Managed Care contracts
Provide the highest level of professionalism, responsiveness, and communication
in order to
build and
maintain
the
maximum
customer base possible
Must
possess
the a
b
ility
to multi-task
and
frequently
change direction
Education and/or Experience
Bachelor’s
D
egree
preferred
or equivalent experience
At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
Minimum two years
in healthcare management manage care environment
and administering contracts
or
equivalent experience
Preferred experience in managing,
analyzing,
and reporting denials and appeals.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee
is regularly required to
talk or
hear
. The employee regularly
is required to
stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions. NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. By supplying your phone number, you agree to receive communication via phone or text. By submitting your application, you are confirming that you are legally authorized to work in the United States. JR# JR249255
#J-18808-Ljbffr
CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission. Summary
The
Director of
Managed Care
will
be responsible for
evaluating, negotiating
,
credentialing, and
securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. Salary Range : $150,000 - $180,000 (DOE) Schedule :
(Remote) Monday - Friday, 8:30am - 5:00pm Location : California Travel : This position is expected to travel up to 25 - 30% for various conferences, sales meetings, etc. with the longest being 4 weekdays at a time Essential Duties and Responsibilities
includ
e
the following. Other duties may be
assigned,
as necessary. Leads the implementation process of managed care contracts and develops and
maintain
systems to
disseminate
contract information
Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
Achieve and
maintain
a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers
Responsible for all aspects of managed car
e
and direct revenue contract management including analysis interpretation, implementation, maintenance of the
contract’s
performance, and payer relations
Responsible for coordination and communication between managed care and other
interested party
departments and leadership
Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
Oversight of payer credentialing
Will
assist
with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
Communicates with respective payers related to trends and compliance with contract parameters
Consistently
represent
s
the company in a professional manner
Maintain effective working relationship and cooperate with all personnel in the Company
Adheres to the
Company’s compliance requirements
as
stated
in the policy and procedure manual and all other related
policies
Perform other duties and responsibilities as assigned
Qualification Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability
required
. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Establish and
maintain
a system of reviewing and assessing changes in the Federal and or State regulations
regarding
Managed Care contracts
Provide the highest level of professionalism, responsiveness, and communication
in order to
build and
maintain
the
maximum
customer base possible
Must
possess
the a
b
ility
to multi-task
and
frequently
change direction
Education and/or Experience
Bachelor’s
D
egree
preferred
or equivalent experience
At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
Minimum two years
in healthcare management manage care environment
and administering contracts
or
equivalent experience
Preferred experience in managing,
analyzing,
and reporting denials and appeals.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee
is regularly required to
talk or
hear
. The employee regularly
is required to
stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions. NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. By supplying your phone number, you agree to receive communication via phone or text. By submitting your application, you are confirming that you are legally authorized to work in the United States. JR# JR249255
#J-18808-Ljbffr