Managed Care Finance Director jobs in Los Angeles, CA

SUMMARY:

The Director of Managed Care Contracts is responsible for the management of all managed care and capitation contracts/amendments, including, but not limited to, professional and facility fee contracts, Letters of Agreement, Letters of Interest, and ensuring contract compliance therewith. Engages in the review of language and terms, and negotiations/renegotiations, develops and updates summarized fact sheets per payer. Develops and identifies potential business opportunities and relationships, to expand Acuity's footprint across all regions.

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required.

• Review contract language, terms and conditions, and negotiate/renegotiate agreements consistent with the terms set forth by the organization.

• Ensure contract terms are consistent with the contracting strategies and negotiated within the established legal and financial guidelines.

• Work with all departments, including Operations, Clinical, Marketing, and Finance to ensure Company is entering into competitive, favorable agreements with payors.

• Administration of Contract Lifecyle Management (CLM) to ensure the streamlining of contract processes, workflows, and execution of all contracts, while ensuring controls are in place.

• Manage the monitoring and maintenance of all contract operations, including, terms, expiration, status, and ensure prompt completion of contracts.

• Identify potential business opportunities and cultivate relationships, to expand organizational growth. Work with Senior Leadership, Operations on contract terms.

• Develop and submit various reports and updates to management regarding current contract and new business development activities.

• Develop, document, and maintain standard operational procedures, checklists, and process flows.

• Ensure deliverables are met and senior management is informed of work progress, timetables, and issues.

• Maintain an appropriate professional appearance and demeanor in accordance with Company policies.

• Maintain strict compliance with State, Federal and other regulations (e.g., OSHA, WC, HIPAA, ADA, FEHA, DOL, HR policies and practices).

• Other duties as assigned by management.

QUALIFICATIONS:

REQUIRED: Bachelor's Degree in related field or equivalent; minimum 5-10 years of contract management experience; extensive knowledge of contract management, contracting concepts and demonstrated knowledge and ability in connection with contract review and negotiations, contract principles, and interpretation of contract language required; knowledge and understanding of HMO, Capitation, POS and PPO contracts; prior staff management experience; excellent written and verbal communication skills; must be proficient in Microsoft Office Suite.

DESIRABLE: Master's Degree in business or related field; prior business development experience; prior experience in the healthcare industry.

KNOWLEDGE/SKILLS/ABILITIES/TALENTS:

• Demonstrated strong analytical, critical & strategic thinking with minimal oversight.

• Proven ability to manage multiple work streams & priorities.

• Detail oriented, organized, process focused, problem solver, self-motivated proactive, customer service focused Clear and effective communicator; adapts to different management, communication & delivery styles.

• Ability to develop effective working relationships.

• Models professionalism by maintaining effective working relationships, following all policies and procedures and approaching challenges with a proactive and positive attitude. Also develops strong, trusted relationships with colleagues and customers.

• Ability to respond to common inquiries from customers, staff, vendors, or other members of the community.

• Ability to draw valid conclusions, apply sound judgment in making decisions, and to make decisions under pressure.

• Ability to interpret and apply policies and procedures.

• Maintains the confidentiality of all business documents and correspondence.