CSI Pharmacy
Overview
CSI Pharmacy (CSI) is a rapidly growing national Specialty Pharmacy. We provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. The Director of Managed Care will evaluate, negotiate, credential, and secure 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 trip being 4 weekdays at a time. Essential Duties and Responsibilities
Leads the implementation process of managed care contracts and develops and maintains 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 care and direct revenue contract management including analysis, interpretation, implementation, maintenance of the contract’s performance, and payer relations Coordinate and communicate between managed care and other interested party departments and leadership Develop new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through revenue cycle operations Oversee payer credentialing Assist with payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education related to contracting Communicate with payers regarding trends and compliance with contract parameters Represent the company professionally Maintain effective working relationships and cooperate with all personnel in the company Adhere to the company’s compliance requirements as stated in the policy and procedure manual and related policies Perform other duties and responsibilities as assigned Qualifications
Establish and maintain a system of reviewing and assessing changes in Federal and/or State regulations regarding Managed Care contracts Provide professionalism, responsiveness, and communication to build and maintain the maximum customer base possible Ability to multi-task and frequently change direction Education and/or Experience
Bachelor’s degree preferred or equivalent experience At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry Minimum two years in healthcare management managed 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, stand, walk, sit, climb stairs, use hands to finger, handle or feel objects, tools, or controls; and reach with hands and arms. Specific vision abilities required include close vision and the ability to adjust focus. Work Environment
The work environment is typical of a clerical office setting. This role routinely uses standard office equipment. Travel by automobile and exposure to changing weather conditions may be required. 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
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CSI Pharmacy (CSI) is a rapidly growing national Specialty Pharmacy. We provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. The Director of Managed Care will evaluate, negotiate, credential, and secure 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 trip being 4 weekdays at a time. Essential Duties and Responsibilities
Leads the implementation process of managed care contracts and develops and maintains 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 care and direct revenue contract management including analysis, interpretation, implementation, maintenance of the contract’s performance, and payer relations Coordinate and communicate between managed care and other interested party departments and leadership Develop new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through revenue cycle operations Oversee payer credentialing Assist with payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education related to contracting Communicate with payers regarding trends and compliance with contract parameters Represent the company professionally Maintain effective working relationships and cooperate with all personnel in the company Adhere to the company’s compliance requirements as stated in the policy and procedure manual and related policies Perform other duties and responsibilities as assigned Qualifications
Establish and maintain a system of reviewing and assessing changes in Federal and/or State regulations regarding Managed Care contracts Provide professionalism, responsiveness, and communication to build and maintain the maximum customer base possible Ability to multi-task and frequently change direction Education and/or Experience
Bachelor’s degree preferred or equivalent experience At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry Minimum two years in healthcare management managed 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, stand, walk, sit, climb stairs, use hands to finger, handle or feel objects, tools, or controls; and reach with hands and arms. Specific vision abilities required include close vision and the ability to adjust focus. Work Environment
The work environment is typical of a clerical office setting. This role routinely uses standard office equipment. Travel by automobile and exposure to changing weather conditions may be required. 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