Director of Managed Care (Sacramento)

At CSI Pharmacy (CSI) , we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care.

CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission.

Summary

The

Director of

Managed Care

will

be responsible for

evaluating, negotiating

credentialing, and

securing 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 being 4 weekdays at a time

Essential Duties and Responsibilities

includ

the following. Other duties may be

assigned,

as necessary.

Leads the implementation process of managed care contracts and develops and

maintain

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 car

and direct revenue contract management including analysis interpretation, implementation, maintenance of the

contracts

performance, and payer relations

Responsible for coordination and communication between managed care and other

interested party

departments and leadership

Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations

Oversight of payer credentialing

Will

assist

with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting

Communicates with respective payers related to trends and compliance with contract parameters

Consistently

represent

the company in a professional manner

Maintain effective working relationship and cooperate with all personnel in the Company

Adheres to the

Companys compliance requirements

as

stated

in the policy and procedure manual and all other related

policies

Perform other duties and responsibilities as assigned

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability

required

• . Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Establish and

maintain

a system of reviewing and assessing changes in the Federal and or State regulations

regarding

Managed Care contracts

Provide the highest level of professionalism, responsiveness, and communication

in order to

build and

maintain

the

maximum

customer base possible

Must

possess

the a

ility

to multi-task

and

frequently

change direction

Education and / or Experience

Bachelors

egree

preferred

or equivalent experience

At least 2 years experience implementing contracted Third-Party programs in the healthcare industry

Minimum two years

in healthcare management manage 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

is required to

stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

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