01 Nov
Director, Hospital Contracting
Florida, South florida , 33101 South florida USA

Vacancy expired!

DescriptionThe Statewide Director, Hospital Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Hospital Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.ResponsibilitiesThe Statewide Director, Hospital Contracting prioritize network needs both quantitatively and qualitatively. Strategize and engage the Hospital Provider community and negotiate contracts that are favorable to CarePlus' business. Ensure that networks are competitive within the industry by helping facilitate sales' ability to penetrate new business opportunities. This position will interact with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high-level executives.Responsible for strategic planning of hospital and physician network development and management

Ensures compliance with pricing guidelines established

Complies with established contract implementation process(s) for all contracts

Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes

Ensures provider contracting is consistent with claim payment methodologies

Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims

Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines

Responsible for compliance with network adequacy standards

Augments and modifies the existing provider network to accommodate new products or clients as necessary

Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and AAHC

Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider initiatives.

Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; works with other departments to develop quality assurance initiatives based on survey results.

Participates in Plan and physician committees as appropriate.

Required QualificationsBachelor's Degree

3 years or more of leadership experience

5 years or more of experience in network management experience, including contracting and network administration within a health solutions company.

5 years or more of experience in negotiating Medicare and Centers for Medicare/Medicaid Services (CMS) reimbursement methodologies with complex hospital systems and/or large physician groups.

Extensive provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development.

Proficiency in analyzing, understanding and communicating financial trends.

Proficient computer skills

Knowledge of Medicare standards and regulations.

Interpersonal and communications skills

Customer Service skills

Strong organizational skills

Valid State of Florida Driver's license

Preferred QualificationsMaster's Degree

Bilingual (English and Spanish), preferred; must be able to read, write and speak English.

Additional InformationWe will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.

Vacancy expired!


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