What are the responsibilities and job description for the Director, Managed Care Negotiations position at Adventist Health?
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Assumes responsibility for Health Plan (managed care) contracting, payer in-servicing, contract implementation and contract reporting across the system. Works in association with the both the corporate and hospital leadership on contract matters. Serves as liaison between the organizations facilities and physicians with affiliated health plans, independent practice associations (IPAs) and other payers. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
Job Requirements:
Education and Work Experience:
- Bachelor’s Degree or equivalent combination of education/related experience: Required
- Master's degree: Preferred
- Seven years' related experience: Preferred
- Five years' leadership experience: Preferred
Essential Functions:
- Maintains focus negotiations responsibility for payer relationships including market parity for contract negotiations for Adventist Health hospitals, surgery centers, home health, hospice, long term care facilities, Adventist Health Physician Network, rural health clinics and other Adventist Health affiliated physician organizations.
- Manages, directs, and leads the departmental staff to ensure maximum productivity and efficiency. Plans/monitors/maintains, FTE, capital, and operational budgets. Reviews department systems, concerns, budgets, and goals with leadership, including cost reduction and revenue enhancement.
- Uses comprehensive knowledge of health plan industry with the ability to review and articulate industry financial and claims data points to both external and internal key stakeholders.
- Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Directs, organizes, and plans the operation of assigned department at the center and market level.
- Ensures compliance with health plan and payer contracts, and local, state, and federal regulations.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.