Dir, Managed Care New! Managed Care Admin | Full-Time | Phoenix ...Read More Quick Apply! Managed Care Admin Type: Location: Phoenix

Phoenix Children's Hospital, Inc.; Phoenix, Northern (AZ, KY); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Phoenix Children's Hospital, Inc. seeks a Director, Managed Care to lead the enterprise-wide payor contracting lifecycle, including negotiation, implementation, and coordination of third‑party payer agreements.

This role oversees Provider Enrollment and Payer Relations, ensuring enrollment accuracy and strong relationships to operationalize contracts across the Phoenix Children’s enterprise. Reports to the VP, Managed Care and supports PC, PCMG and PCCN relationships.

Responsibilities

• Directs all contracting activities for the enterprise-wide payor contract portfolio.
• Oversees the activities of the Provider Enrollment staff to ensure timely and accurate enrollment of facilities and employed providers with contracted payers.
• Educates network providers and staff on key managed care principles, market trends, and opportunities for improvement.
• Coordinates and leads activities using a collaborative and team approach to implement contracts and achieve department goals.
• Plays a key role in managing relationships for network hospitals, physicians, ancillary providers and vendors related to managed care agreements.

Skills

Contract negotiations

Payer relations

Leadership

Project management

Training & education

Job description

The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PC, PCMG and PCCN contractual relationships.

Position Duties

• Directs all contracting activities for the enterprise-wide payor contract portfolio.
  Directs contracting staff activities to achieve optimal contract financial and operational outcomes as well as effective contract management. Responsible for contract negotiations, including rates, payment methodologies, contract language and value based payment programs in accordance with internal control processes for contract review, approval and signature. Ensures contracts are negotiated within established parameters and acceptable time frames for maximum performance. Makes recommendations for contract strategies.
• Oversees the activities of the Provider Enrollment staff.
  Oversees the activities of the Provider Enrollment team to ensure timely and accurate enrollment of facilities and employed providers with contracted payers. Ensure compliance with credentialing, recredentialing and delegated credentialing requirements related to Provider Enrollment. Monitor and update provider demographic information.
• Educates network providers and staff on key managed care principles, market trends, and opportunities for improvement in support of enterprise goals and objectives
  Prepares and provides training on pertinent subject matter to network providers. Proactively communicates and educates operational areas on contract changes, policy updates, etc. To ensure staff have information needed to successfully implement and operationalize agreements. Participates in or conducts presentations as needed.
• Coordinates and leads activities using a collaborative and team approach.
  Demonstrates attention to detail, strong interpersonal skills, and project management skills to effectively conduct team meetings, engage team members, secure cooperation, and accomplish department goals and objectives. Handles multiple projects and ensures teams perform as needed under tight deadlines with a focus on effective implementation, communication and follow-up. Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group`s achievement of goals and to help foster a positive work environment.
• Plays a key role in managing relationships for network hospitals, physicians, ancillary providers and vendors related to managed care agreements.
  Ensures contracting, payor relations and