Job Description Job Description Eastridge Workforce Solutions is a leading provider of workforce management solutions, dedicated to connecting skilled professionals with rewarding opportunities. In partnership with a well-established healthcare fund management firm, we are searching for an experienced Director of Managed Care and Vendor Administration . This role is responsible for overseeing the strategic direction, planning, and management of managed care vendor contracting and monitoring. The position involves implementing innovative contracting strategies like direct contracting, risk-sharing, narrow networks, bundled payments, and value-based contracting, particularly with providers at Health Centers. The role requires employing consultants and collaborating with experts to identify opportunities.KEY ACCOUNTABILITIESWorking with executive leadership and operational management to develop and manage MCVAs strategic goals and operational deliverablesProvide expertise in innovative contracting and explore new opportunities to increase quality and decrease costCoaching and directing the Aurora-based MCVA Team that manages day-to-day contractual relationships with vendors and plays a key role in contractingLeading the team of MCVA staff for the Aurora-based Plans Units and providing guidance to the Las Vegas-based Hospitality Plan management.Managing the administration, coordination, negotiation, and execution of all managed care vendor and provider contracts and amendments.Overseeing relationship management, identifying trends, and resolving escalated issues for Aurora-based Plan Unit vendors and providers.Directing contract performance analysis across utilization, financial, operational, and service dimensions.Coordinating vendor-issue resolution and implementation efforts across various departments.Managing the Trustee Service Provider Resolution process and the Service Provider Vendor Bid Process and Vendor Monitoring Program for both Aurora-based and Las Vegas-based plans.Additionally, the role involves planning, analyzing, and evaluating programs and services, supervising and developing staff, and recommending staffing decisions. The position also encompasses developing policies, overseeing employee training, promoting diversity and inclusion, and maintaining knowledge of diversity-related best practices and legislation.ESSENTIAL QUALIFICATIONS10 12 years or more of experience in a healthcare, managed care, or insurance organizationRequires an excellent understanding of, and experience in leading, contracting efforts of the full range of managed care and healthcare approaches, including innovative models such as risk-sharing arrangements and capitation, as well as more unique and/or direct-provider arrangements including ancillary contracting effortsStrong working knowledge of current legislative requirements under ACA, COBRA, HIPAA, DOL, etc. as related to health benefits, eligibility, payment, appeals, etc.Strong data and financial analysis acumen and experienceStrong report writing and presentation experienceDemonstrated strong leadership and interpersonal skills to lead others to achieve results in a team-oriented environmentKnowledge of an experience working with union or Taft-Hartley Trust Funds are plusesBachelor's degree in Business, Healthcare Administration, related field or equivalent work experience requiredPreferred: Masters degreeIntermediate level Microsoft Office skills (PowerPoint, Word, Outlook)Intermediate level Microsoft Excel skills15% ~ 25% travel required based on business needsBenefits: We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).Eastridge Workforce Solutions is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees. Please note that Eastridge is unable to provide visa sponsorship to applicants.Certain clients require Eastridge to perform background checks and Eastridge will consider qualified applicants with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds.#IPROPLUS#LI-BL2#J-18808-Ljbffr

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