Director Managed Care Job Description

Director Managed Care Job Description

4.7
194 votes for Director Managed Care
Director managed care provides training and support to CTMC PFS department and CTPN providers regarding managed care contracts, co-plans, and any managed care related issues affecting these respective staff members.

Director Managed Care Duties & Responsibilities

To write an effective director managed care job description, begin by listing detailed duties, responsibilities and expectations. We have included director managed care job description templates that you can modify and use.

Sample responsibilities for this position include:

Assists in the development and recruitment of new partners
Researching, evaluating, resolving contract issues
Building consensus among internal and external constituents in order to resolve operational issues
Reporting on and measuring work efforts
Monitoring contract operational performance
Provides day to day leadership of Managed Care personnel with a focus on professional development
Provide managed care support and expertise by attending scheduled meetings with operations leadership, including Division/Market/Practice operations management
Develop and implement, in conjunction with the Service Center an annual operating plan and managed care strategic plan
Coordinate and administer managed care contract negotiation process for designated Division/Market/Practice Management
Oversee individual practice managed care contracting efforts

Director Managed Care Qualifications

Qualifications for a job description may include education, certification, and experience.

Education for Director Managed Care

Typically a job would require a certain level of education.

Employers hiring for the director managed care job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Business, Education, Business/Administration, MBA, Finance, Healthcare, Health, Management, Accounting, Healthcare Administration

Skills for Director Managed Care

Desired skills for director managed care include:

Post-Acute industry
Managed Care environment
State and federal legislative and regulatory laws and rules regarding managed care
Administrative
Contractual
Health insurance and operational issues related to managed care organizations
Hospitals and health insurance benefit plan designs
Physician groups
FMCNA products
Organizational objectives

Desired experience for director managed care includes:

Ability to assist in the development and recruitment of new partners
10 years of progressive healthcare industry experience, preferably at a health plan or PBM
Deep industry connections with Pharmacy leaders at health plans or PBMs
5+ years in project management, strategy, business development, and/or consulting
In depth knowledge of the pharmacy environment
Strong understanding of dynamics of the pharmacy managed care industry

Director Managed Care Examples

1

Director Managed Care Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of director managed care. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for director managed care
  • Coordinate significant managed care analysis and activities with PHO/IPA operators and managed care operations management as appropriate
  • Oversee respective service center managed care compliance efforts
  • Maintain permanent record of all major payor contracts for respective service center market
  • Administer protocols to ensure smooth and timely implementation of contract terms
  • Prepare monthly reports to summarize managed care negotiation activities in theDivision /Market/Practice
  • Analyze performance and provide evaluation on all existing contracts to operations management annually and/or as requested
  • Design and direct Market projects as requested by leadership
  • Administer company’s guidelines for managed care contracting and compliance
  • Market Managed Care Product line
  • Oversees and participates in the development, negotiation, implementation, monitoring and management of all physician managed care agreements
Qualifications for director managed care
  • Proven ability to lead, persuade, and influence as it relates to customer relationships and business development
  • Notable knowledge, credibility, and significant senior level executive relationships with the health plan industry along with strategic business development skills necessary to personally lead negotiations
  • Ability to understand market research / customer needs and synthesize that information to identify growth opportunities
  • Experience and knowledge in provider innovation development activities to develop strategies, drive successful implementation and drive innovation
  • Strong ability to ‘sell’ ideas and strategies to physicians and practice leadership
  • A work record that demonstrates clear and effective communication skills, strong analytical skills, detail orientation, strategic agility and strong negotiation skills
2

Director Managed Care Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of director managed care. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for director managed care
  • Coordinate with Physician Services’ Revenue Cycle Group to assure contract compliance and troubleshoot reimbursement issues
  • Provides leadership in the development, direction, execution, and evaluation of an effective care coordination program that supports the delivery of quality healthcare in the most appropriate and effective manner
  • Develops a set of benchmarks to evaluate the care coordination program effectiveness and efficiency
  • Provides leadership, guidance and structure to remote care coordinators
  • Creates a structure and system that efficiently identifies the number of care coordinators required based on the number of beneficiaries and specific program involvement
  • Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure and to adapt to changing priorities
  • Responsible for the planning, priority setting, coordination, implementation, evaluation and reporting of programs related to patient care coordination
  • Develops systems to ensure effective communication and coordination between the care coordination team and quality and government programs, division leadership, PSG operations, and Strategic Pricing and Analytics
  • Collaborates with interdisciplinary teams and leaders to achieve the organization’s coordination of care goals, quality goals, and financial performance goals
  • Directs the preparation and maintenance of care coordination reports and prepares periodic reports for senior management, as required
Qualifications for director managed care
  • Proven leadership and ability to motivate team members
  • Strong organizational and interpersonal skills ability to build lasting client relationships
  • Deep relations with key national and regional payers
  • Demonstrated knowledge of managed care processes and provider network development processes
  • Demonstrated knowledge of managed care lines of business, including Medicare, state Medicaid and Commercial HMO products
  • PharmD and/or MBA strongly preferred
3

Director Managed Care Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of director managed care. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for director managed care
  • Ability to think strategically and anticipate future changes with a performance excellence, outcomes-focused mindset
  • Prepares and submits minutes from all meetings
  • In coordination with the Clinical Services Group (CSG), develops and implements programs, initiatives, and improvement strategies to ensure consistency in compliance with applicable laws, regulations, and other governmental requirements
  • Monitors and communicates with Operations regarding care coordination trends
  • Facilitates effective communication with Physician Services Group regarding key care coordination activities and initiatives
  • Lead, manage and develop direct reports and, where applicable, ensure appropriate management of your indirect reports
  • Enable Genentech to stay ahead of access marketplace dynamics and other developments, as these pertain to patient access and emerging customers
  • Oversee, guide and drive innovative reimbursement and emerging customer recommendations and strategies that optimize formulary positioning, reimbursement, access and overall market share for our pipeline and marketed products
  • With the RSEC team, expertly educate others on the U.S. and related managed care landscape, as this relates to patient access and emerging customers
  • Ensure timely and targeted managed care landscape surveillance and research to identify important trends or other activities
Qualifications for director managed care
  • Knowledge and use of web/digital assets management and optimization tools & solutions (traffic monitoring and analysis solutions, SEO/SEM
  • 10 plus years related industry experience
  • Strong relationships with people in the industry
  • Develop and deliver new hire MMCD/MSL/RMA continuous learning and management development courses for the North American (NA) MMCD and MS Field Medical Organization
  • Plan, coordinate, and implement all required training meetings (virtual, on-site/offsite)
  • Develop and implement coordinated annual training plan for (NA) MMCD and MS Field Medical that includes scientific training curriculum and professional skills development
4

Director Managed Care Job Description

Job Description Example
Our growing company is looking to fill the role of director managed care. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for director managed care
  • Build relationships with all relevant internal partners and stakeholders and ensure the same across your team
  • Oversee and help ensure cross-functional pull-through of reimbursement and emerging customer strategies to position Genentech for effective go-to-market execution
  • Work with Genentech executives to transfer and leverage learning across brands and business segments
  • Preparing reports and presentations to monitor portfolio performance, yield, payer enrollment, payer mix
  • Building on a network of current and potential free standing Outpatient Women’s Health, Maternity and Pediatrics Centers
  • Developing and maintaining meaningful relationships with Health System Partners
  • Developing a full range of contract relationships with managed care organizations
  • Staying abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models
  • Identifying the tools, resources and talent needed to support the company growth goals
  • Keeping the Executive Leadership team informed of new and pertinent developments in the region
Qualifications for director managed care
  • Work closely with Director of Field Medical Operations, Field Medical Training Taskforce, Field Medical Work teams, and Home Office Medical Affairs to identify training needs and implement plans to address needs
  • Assist with needs analysis to determine key performance/skill and knowledge gaps for Field Medical (including US and Canada) and Home Office Medical Teams, and development and implement training programs based upon identified gaps
  • Identify, select and manage vendors for curriculum design/development and manage vendor relationships for existing training platform systems
  • Serve as team liaison to MS BU Sales Training and USMA training colleagues and help coordinate MMCDs and MSL support of commercial training needs (e.g., POA workshops).• Lead Field Medical Training Taskforce which includes MMCD, MSL and Canadian RMA representation
  • Support North American Field Medical Centre of Excellence by leveraging US/global field medical training programs/meetings/resources for Canadian RMAs, and identifying supporting unique training needs of RMAs as appropriate
  • Ensure consistency of training and certification and skill development across NA field medical teams
5

Director Managed Care Job Description

Job Description Example
Our growing company is looking to fill the role of director managed care. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for director managed care
  • Provides documentation including financial and operational analysis supporting strategic imperatives, infrastructure, and budget and system requirements
  • Provides consultative advice to key system stakeholders to enable operational and financial improvement across system service lines including ambulatory, hospital, behavioral health and employed and affiliated physicians
  • Maintains and grows strong working relationships with key external (payor) and internal (system operational) contacts, fosters effective communication, and provides education regarding payor contract obligations, performance and updates
  • Utilizes knowledge of fee-for-service, professional and global risk financial and operational contract rates, terms, conditions and obligations to coordinate with internal decision support and external payors to validate performance according to expectations and forecasted projections
  • Ensures all coding and policy and procedure changes are monitored, managed and communicated to all key internal stakeholders
  • Communicates with managed care payors to ensure updates are implemented and promotes the listing of all sites and services in payor on-line and other directory and member communication materials
  • Completes summary reviews of financial and operational performance for budget forecasting
  • Supervises support staff in managing and maintaining credentialing and re-credentialing activities for new and existing system sites and services
  • Reviews contract language with the office of legal affairs and requests appropriate changes
  • Coordinates payor modeling and analysis as assigned and independently oversees modeling and analysis for assigned sites and services
Qualifications for director managed care
  • Support unique training needs for NA Home Office Medical colleagues with input from NA MA VP, including support of NA MA professional development curriculum
  • Work closely with field management providing/developing timely training solutions on Field Medical topics
  • Manage other training projects as assigned by the Field Medical Leadership
  • Identify and develop alternative training venues (e.g., podcasts, archived training options) to enhance flexibility and delivery of training offerings
  • Continuous refinement of the Field Medical training curriculum
  • Identify opportunities for improved field utilization of learning management systems

Related Job Descriptions

Resume Builder

Create a Resume in Minutes with Professional Resume Templates