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DIRECTOR MANAGED CARE

City:  Cincinnati
State:  OH
Job Requisition Number:  259321

Attention current TriHealth employees:

Please apply for this position by submitting an online internal application via SuccessFactors. Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.

DIRECTOR MANAGED CARE: Director Managed Care Contracting and Payor Relations is responsible for evaluating, negotiating, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations on behalf TriHealth. Additionally, this individual will participate in and support the development of managed care strategies and initiatives for TriHealth to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including - but not limited to - accountable care organizations (ACOs) and clinically integrated networks (CINs). The leader will foster professional relationships with payor executives and serve as a liaison between TriHealth and payors. This individual will also be responsible for representing the interests of TriHealth in in discussions related to managed care and all aspects of the day-to-day operations of managed care, including provider contracts services, grievances/appeals, inquiries/complaints for the commercial and government-sponsored business segments. MINIMUM REQUIREMENTS:

EDUCATION: Bachelor's Degree in business, healthcare administration, or related field EXPERIENCE: 7-10 years Management in managed care environment, health insurance industry, or managed care product development/negotiations

SPECIALIZED KNOWLEDGE: Exp with contract negotiations, payor relations, managed care ops, MD/professional service comp, fee schedules, recourse-based relative value scale based reimbursement, payor denial management, contestations, audits, and appeal resolution.

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Job Title:  DIRECTOR MANAGED CARE

Department Name:  TRIS MANAGED CARE CONTR

Location:  Baldwin

Hourly/Salaried:  Salaried

Employment Status: Full Time Position

Bi-Weekly Hours:80

Shift: Day Shift

Weekend Commitment:  No

Holiday Commitment:  No

On-Call Commitment:  No


Nearest Major Market: Cincinnati

Job Segment: Healthcare Administration, Hospice, Clinic, Palliative, Manager, Healthcare, Management