Director Managed CareConway Medical Center • Conway, South Carolina, United States, 29526
Director Managed Care
Conway Medical Center • Conway, South Carolina, United States, 29526
Hace 8 días
Tipo de contrato
- A tiempo completo
Descripción del trabajoMinimum 6 years’ experience in working with acute care facilities required. Minimum 3 years’ healthcare insurance payer contracting negotiations experience preferred. Excellent communication and critical thinking skills. Passionately believes in the core values of excellence, compassion, healing, teamwork, stewardship, innovation, integrity and is a champion of CMC core values and model for all. Ability to work effectively and collaboratively with leadership colleagues, physicians, department heads, and members of the executive leadership. Demonstrated proficiency with Microsoft Outlook, Word, Excel, Explorer and PowerPoint required with samples presented if requested during interview. Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations. Demonstrates the ability to interact with others in a way that gives them confidence in intentions and those of the organization. Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying own behavior to accommodate tasks, situations and individuals involved. Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral / written communication skills. Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences. Extensive knowledge of regulatory and accreditation agency requirements that impact department; stays abreast of industry changes. The ability to work effectively in a fast-paced environment demonstrates flexibility and adaptability in the workplace. Capable of leading teams / facilitating groups, building consensus and garnering highest confidence in professionalism and work product by leadership. Ability to work under pressure and balance many competing priorities; highly responsive and solution / action oriented. Maintains a positive and supportive attitude and demeanor always as Professional handling of exposure to confidential / sensitive information. Demonstrated history of innovation and results focused outcomes. Works closely with RCM team, finance, and others to secure appropriate payment under our revenue cycle operational activities and leading settlement efforts on old, unpaid claims that need to be closed out. Supports the payor’s needs for any identified acquisition opportunities within the territory with both due diligence and integration of key payors and credentialing. These drive change in a large, highly matrixed organization, leveraging data, analytics, and best-in-class technology to deliver revenue uplift. Responsible for building effective internal partnerships and promoting collaborative relationships with regional leadership and enterprise shared services, including finance, reimbursement, payer contracting, information technology, legal, and compliance. Maintains current knowledge of industry trends and regulatory requirements and has considerable expertise in payer contracts. Works collaboratively with RCM system leadership to develop and execute system payer and network development strategy. Maximizes operational standards related to third party payment and facilitates enhanced access to the organization for members of the community. Integrates and aligns payer strategy with CMC’s strategic objectives, including population health strategies, value-based contracting strategies, contract management, operations processes, and government reimbursement trends. Includes integration (relative to payer strategy) across key CMC functional areas of Revenue Cycle Management, Finance, Reimbursement, Legal, Business Development, and Health Plan Operations. Provide financial and contract-based decision support and program analytical services to support business development and operational decision making and payor contracting. Responsible for Conway Medical Center (CMC) payor contract builds, modeling, integration, and coordination from request to approval and into production. Serves as a revenue cycle expert for CMC migration, integration, and modeling of payor contracts into Cerner contract management platform. Advises and directs management staff on higher level decisions or problem resolutions to support payment variance contract assessments, quality assurance, build investigation, contract integration, and operational contract interpretation. Management of staff oversight for evaluating system build and reconciliation process to ensure accurate contractual are taken at the time of billing per the analysis, review, and maintenance of CMC’s Contract Management applications as outlined in the payor contract language. Manages various department reports, both ad-hoc and routine, to assist in the identification of payment variance opportunities and other payment irregularities. Works with the Denial department with the build and modeling of contract proposals, including what-if scenarios, to demonstrate potential reimbursement, opportunities and / or shortfalls. Ensures CMC patient accounts have an accurate expected reimbursement per the managed care contract language and system build. Works directly with managers in managing vendor partners and acts as vendor liaison to reduce revenue leakage from Conway. Completes other duties as assigned by department leadership
This is a hybrid position where the Director Managed Care will work from home but will,
be expected to be on-site when requested.
Position Summary :
The Director of Managed Care (D-MC) is responsible for identifying and negotiating local / regional Managed Care and Governmental agreements with applicable health plans identified via the Company and Regional Payor Strategy. The D-MC will work with our licensing, operations, and credentialing team to identify and assure the credentialing of our Providers and facilities is completed and updated as needed.
Qualifications : Education :
- Bachelor's degree in Business Administration, Accounting, Health Care Management, Information Systems, or a quantitative field of study (i.e., mathematics, economics, sciences, finance, etc.).
- Master’s degree in Business Administration preferred.
Experience
Special Skills :
Duties & Responsibilities :
PIfeb4a5fd149a-30511-38879314
Crear una alerta de empleo para esta búsqueda
Director Managed Care • Conway, South Carolina, United States, 29526
Ofertas relacionadas The Director of Quality (D-Q) is responsible for establishing a corporate quality management system and team that promotes excellent quality of care and that positively impacts the financial perfor...Mostrar más 
WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country.
You also get unmatched service.From the moment y...Mostrar más
Vetted is seeking a RN - OR - Operating Room for a travel job in Lumberton, North Carolina.The job was posted 18 days ago.
The assignment starts on ASAP and is 13 weeks long with 8 hour shifts 5 day...Mostrar más
Advance your career as an Emergency Medicine (EM) Medical Director at McLeod Health Seacoast Medical Center, a Level III trauma center on the coast!.
Must be board certified / board eligible in Emerge...Mostrar más WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country.
You also get unmatched service.From the moment y...Mostrar más 
Licensed Psychiatric Nurse Practitioner.Wage : Between $130-$203 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you wa...Mostrar más WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country.
You also get unmatched service.From the moment y...Mostrar más 
Resident Care Associates to join their team!.Mon-Fri; Every other weekend required.The Resident Care Associate reports directly to the Family Experience Director, Pearl Director or the Assistant Fa...Mostrar más
MUSC Marion is looking for an experienced Nurse Leader to lead their Inpatient Services Team (Med / Surg, IMCU, Swing Bed).
Awesome state health benefits and retirement.Up to 6 weeks PAID Parental Lea...Mostrar más
Job Summary Our Medline Acute Care sales team serves as the main interface for various segments in the hospital such as OR, Cath Lab, ICU, Labor and Delivery, Emergency Department, Materials Manage...Mostrar más
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Hemingway, SC.
This unique opportunity adapts to your...Mostrar más
Ensure that consumers living in the residential facility are receiving services that are safe, therapeutic, and support the consumer in achieving his / her personal goals.
Hours vary based upon client...Mostrar más Vetted is seeking a RN - OR - Operating Room for a travel job in Lumberton, North Carolina.The job was posted 18 days ago.
The assignment starts on ASAP and is 13 weeks long with 8 hour shifts 5 day...Mostrar más 
Assistant Rehab Director PT, SLP, PTA, COTA.Skilled Nursing Facility / CCRC Campus.We are seeking an experienced Assistant Rehab Director who has their South Carolina License as either a PT, SLP, PT...Mostrar más Licensed Marriage and Family Therapist (LMFT).Wage : Between $90-$127 an hour.Licensed Marriage and Family Therapist — Are you ready to launch or expand your private practice? .Headway is...Mostrar más Vetted is seeking a RN - OR - Operating Room for a travel job in Lumberton, North Carolina.The job was posted 18 days ago.
The assignment starts on ASAP and is 13 weeks long with 8 hour shifts 5 day...Mostrar más Lead Med Tech to join their team!.Med Tech / Certified Medication Aide.The Lead Med Tech is responsible for monitoring the health and well being of our residents and provides leadership support and...Mostrar más 
People are a company's greatest resource, which is why caring for employees and keeping them healthy is so important.Proactive MD offers a comprehensive health management solution that extends ...Mostrar más
Director of Quality
Conway Medical Center • Conway, South Carolina, United States, 29526
A tiempo completo
Última actualización: hace 3 días
Travel - Cath Lab Tech
Titan Medical Group • Gresham, SC, US
A tiempo completo
Última actualización: hace 8 horas • Oferta promocionada • Nueva oferta
RN - OR - Operating Room in Proctorville, NC - $2,058 / week
Vetted Health • Proctorville, NC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
Medical Director
TeamHealth • North Myrtle Beach, SC, United States
A tiempo completo
Última actualización: hace 5 días • Oferta promocionada
Travel - MRI Tech
Titan Medical Group • Gresham, SC, US
A tiempo completo
Última actualización: hace 8 horas • Oferta promocionada • Nueva oferta
Licensed Psychiatric NP
Headway • Hilton, SC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
Travel - CT Technologist
Titan Medical Group • Fairmont, NC, US
A tiempo completo
Última actualización: hace 8 horas • Oferta promocionada • Nueva oferta
Resident Care Associate
Myrtle Beach Manor • Myrtle Beach, SC, US
A tiempo completo
Última actualización: hace 5 horas • Oferta promocionada • Nueva oferta
Nurse Manager of Inpatient Services (Med / Surg / IMCU & Swing Bed), FT
MUSC • Marion, SC, US
A tiempo completo
Última actualización: hace 5 horas • Oferta promocionada • Nueva oferta
Medical Supply Sales Representative
Medline Industries - Transportation & Operations • Conway, SC, US
A tiempo completo
Última actualización: hace 10 días • Oferta promocionada
Nurse Practitioner (PRN) - Health Risk Assessments
Hueman Risk Adjustment • Hemingway, SC, US
A tiempo completo
Última actualización: hace 29 días • Oferta promocionada
Home Manager
Serenity Therapeutic Services, Inc. • Whiteville, NC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
RN - OR - Operating Room in Fairmont, NC - $2,058 / week
Vetted Health • Fairmont, NC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
Assistant Rehab Director
Broad River Rehabilitation • Myrtle Beach, SC, US
A tiempo completo
Última actualización: hace 14 días • Oferta promocionada
Licensed Marriage and Family Therapist
Headway • Hilton, SC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
RN - OR - Operating Room in Orrum, NC - $2,058 / week
Vetted Health • Orrum, NC, US
A tiempo completo
Última actualización: hace más de 30 días • Oferta promocionada
Lead Med Tech
Myrtle Beach Manor • Myrtle Beach, SC, US
A tiempo completo
Última actualización: hace 5 horas • Oferta promocionada • Nueva oferta
(PRN) Family Nurse Practitioner
Proactive MD • North Myrtle Beach, SC, US
A tiempo completo
Última actualización: hace 2 días • Oferta promocionada