Executive Director, Managed Care

Executive Director, Managed Care ECU Health

• 3.7 Greenville, NC Job Details Full-time $143,041.60
• $236,038.

40 a year 1 day ago Qualifications Collaborate with healthcare professionals Revenue growth Term negotiation Contract management Stakeholder engagement Managerial strategic planning Strategic management Contract review Financial model construction Operations management Organization design Financial model development Competitive analysis Regulatory compliance Valuation Data analysis skills Contract management in healthcare Performance management 3 years Master's degree Change management Policy & process development Bachelor's degree Team management Decision making Budgeting Senior level Strategic partnerships Leadership Healthcare compliance Stakeholder relationship building Stakeholder management Full Job Description Position Summary Translate strategies into actionable initiatives that enable achievement of results that align with established goals to create and sustain operational excellence for health care entities and programs. Leads the integration and provides ultimate oversight for multiyear strategies to advance managed care. Understands the competitive marketplace characterized by managed care penetration, integrated health delivery, population health and network/partnership development. Understands traditional managed care and new value-based arrangements and to negotiate contracts and considers the benefits and risks of various contractual arrangements. Works in partnership with management and physician leaders in ensuring that plans, operations and patient care are aligned with the Mission, Vision and Values. Ensures broader organizational support around identified goals, strategies, budgets, and metrics associated with the managed care function. Ensures that policies, procedures and practices are operationalized to support safe, reliable care and fosters a continuous learning culture. Builds the organizational structure, talent, and other capabilities to implement and operate the managed care function. Responsible for establishing, measuring, and achieving performance metrics, consistent with ECU Health expectations. Employs methods of change management to advance the organization by using tools, business processes, budget allocations and operational practices to significantly reshape ECU Health. Accountable for a positive organizational culture in conducting business, decision making and performance management to influence work attitudes and enhance job satisfaction. Member of system management teams and functions as a key liaison between the leadership teams and physician partners and applicable programs.

Scope:

ECU Health is a not-for-profit health system. The ECU Health System is made up of 15,000 team members, nine hospitals, and ECU Health Medical Group with 1,200 providers in 120 practice sites. ECU Health is affiliated with The Brody School of Medicine at East Carolina University. The mission driven 1,708-bed health system serves more than 1.4 million people in 29 eastern North Carolina counties. Responsibilities Oversees the development, strategic planning and execution of managed care contracts in partnership with advisement partners. Oversees all aspects of evaluating, developing, analytic valuations and negotiating fee for service, value-based and special program contracts and more broadly contributes to efforts to develop and execute strategies to strengthen position in the evolving managed care marketplace. Representative of organization to outside payors while building and maintaining strong relationships with health plan partners and develop positive brand recognition. Develops strong relationships with internal clinical providers and groups. Provides direction and oversees management of area and develops and implements policies and procedures for area of responsibility. Oversees strategy development includes market assessment, financial modeling, relationship management with employers and payors. Oversees the negotiation of contracts which includes assessing legal and financial implications of all contracting opportunities including new contracts, renewal contracts, contractual amendments and assignments to existing contracts. Responsible for revenue enhancement targets through contracting, contract management as well as creating alignment to meet organizational goals and objectives. Oversees the analysis of data and assesses market information and intelligence to create strategic plans. Works in conjunction with the office of general counsel to ensure that transactions are legally and contractually sound and in accord with the policies. Regularly assesses progress on plans and achievement of agreed-upon performance measures and provides periodic reports to key stakeholders. Ensures development and effective administration of appropriate processes for compliance with applicable governing and regulating bodies, licensure, laws and regulations. Provides leadership and vision to staff in areas of accountability related to long range planning and development. Facilitates positive relationships and communications between departments and key stakeholders, through various means, such as conducting and attending meetings, rounding, having one-to-one communications, and generally being visible and accessible to colleagues and staff. Minimum Requirements Bachelor's Degree is required

• Master's Degree preferred. 8 to 10 years of experience in payor contracting, payor relations is required. 3 to 5 years of leadership experience is required. Solid skills in business acumen and analytic modeling. Pay Range $143041.60
• $208494.00 Other Information Remote role Monday
• Friday day shift: 8:00 a.m.
• 5:00 p.

m., flex as needed Ability to travel to ECU Health in Greenville, NC at least once per quarter, and to conferences, other events, as needed. Great Benefits #

LI-REMOTE

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LI-AH2 ECU

Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research. General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification. We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.