Fresenius Medical Care
Overview
Join to apply for the
Director of Managed Care
role at
Fresenius Medical Care Purpose and scope: Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc) in the state of California. Oversees Division's contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments. Develops and directs regional marketing efforts to third party payors in order to support growth and profitability in the region.
Responsibilities
Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
Reviews and analyzes potential contracts for financial effect, cost benefit and utilization.
Negotiates contractual relationships with managed care organizations and other third party payors as needed.
Presents contract proposals and market and industry analyses to internal parties and responds to Requests for Proposals from third party payors.
Manages activities concerned with contracts for delivery systems.
Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives. Has significant project/process responsibility within the function.
Interprets company-wide policies and procedures. Involved in the development, modification and execution of company policies that affect immediate operations with potential company-wide effect. Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results.
Ensures compliance of facilities with all managed care organization requirements; ensures credentialing processes are implemented. Ensures all facilities meet and maintain appropriate credentialing requirements and licenses.
Develops and implements methods and procedures for monitoring work activities and informs management of current work activity status.
Responsible for continuous communication and coordination of all required ongoing documentation with appropriate staff.
Works with internal and external counsel as needed to resolve issues and support FMCNA.
Negotiates and implements contracts with payors that require clinical and quality outcomes measurements.
Contributes to the design and implementation of third party payor compensation structures.
Assists in the development of report cards that can be shared with third party payors illustrating outstanding quality of patient care through associated outcomes; ensures quality outcomes are reported accurately and in a timely manner.
Assists with designing Quality Improvement Projects that will improve outcomes in facilities that are not meeting goals.
Develops and implements regional marketing plans to support regional growth and profitability and marketing of FMS services to third party payors and potential referral sources.
Maintains knowledge of FMCNA products, services and strategies to market appropriately; stays current on community healthcare market and industry issues that may impact the business.
Generally manages department budget and day-to-day functions. Develops budgets, schedules and performance standards. Exercises supervision in terms of costs, methods, and staffing.
Responsible for implementation and achievement of business plan, budget, key performance indicators and communication to appropriate executives.
Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution. Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.
Provide technical guidance. Assist with various projects as assigned. Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
Education and Experience Education:
Bachelor's Degree in Business or Health management required; Advanced Degree desirable.
Experience and required skills:
6 - 8 years' direct experience in contract negotiation and operational experience in a multiple site outpatient facility setting including profit and loss responsibility.
3+ years' experience as a Manager preferred.
Demonstrated ability to manage one or more departments.
Ability to manage databases and provide analysis.
Proficient with PCs, Microsoft Office applications and business computer systems.
Strong oral and written communication skills.
The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies.
Range:
$120,000 - $200,000
Benefits and Other Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance.
EEO:
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. EOE, disability/veterans
Job Details
Seniority level: Director
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
Location: Inglewood, CA
Referrals increase your chances of interviewing at Fresenius Medical Care by 2x. Get notified about new Director of Managed Care jobs in Inglewood, CA.
#J-18808-Ljbffr
Join to apply for the
Director of Managed Care
role at
Fresenius Medical Care Purpose and scope: Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc) in the state of California. Oversees Division's contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments. Develops and directs regional marketing efforts to third party payors in order to support growth and profitability in the region.
Responsibilities
Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
Reviews and analyzes potential contracts for financial effect, cost benefit and utilization.
Negotiates contractual relationships with managed care organizations and other third party payors as needed.
Presents contract proposals and market and industry analyses to internal parties and responds to Requests for Proposals from third party payors.
Manages activities concerned with contracts for delivery systems.
Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives. Has significant project/process responsibility within the function.
Interprets company-wide policies and procedures. Involved in the development, modification and execution of company policies that affect immediate operations with potential company-wide effect. Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results.
Ensures compliance of facilities with all managed care organization requirements; ensures credentialing processes are implemented. Ensures all facilities meet and maintain appropriate credentialing requirements and licenses.
Develops and implements methods and procedures for monitoring work activities and informs management of current work activity status.
Responsible for continuous communication and coordination of all required ongoing documentation with appropriate staff.
Works with internal and external counsel as needed to resolve issues and support FMCNA.
Negotiates and implements contracts with payors that require clinical and quality outcomes measurements.
Contributes to the design and implementation of third party payor compensation structures.
Assists in the development of report cards that can be shared with third party payors illustrating outstanding quality of patient care through associated outcomes; ensures quality outcomes are reported accurately and in a timely manner.
Assists with designing Quality Improvement Projects that will improve outcomes in facilities that are not meeting goals.
Develops and implements regional marketing plans to support regional growth and profitability and marketing of FMS services to third party payors and potential referral sources.
Maintains knowledge of FMCNA products, services and strategies to market appropriately; stays current on community healthcare market and industry issues that may impact the business.
Generally manages department budget and day-to-day functions. Develops budgets, schedules and performance standards. Exercises supervision in terms of costs, methods, and staffing.
Responsible for implementation and achievement of business plan, budget, key performance indicators and communication to appropriate executives.
Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution. Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.
Provide technical guidance. Assist with various projects as assigned. Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
Education and Experience Education:
Bachelor's Degree in Business or Health management required; Advanced Degree desirable.
Experience and required skills:
6 - 8 years' direct experience in contract negotiation and operational experience in a multiple site outpatient facility setting including profit and loss responsibility.
3+ years' experience as a Manager preferred.
Demonstrated ability to manage one or more departments.
Ability to manage databases and provide analysis.
Proficient with PCs, Microsoft Office applications and business computer systems.
Strong oral and written communication skills.
The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies.
Range:
$120,000 - $200,000
Benefits and Other Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance.
EEO:
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. EOE, disability/veterans
Job Details
Seniority level: Director
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
Location: Inglewood, CA
Referrals increase your chances of interviewing at Fresenius Medical Care by 2x. Get notified about new Director of Managed Care jobs in Inglewood, CA.
#J-18808-Ljbffr