Director Managed Care - Managed Care Contracting

This position provides strategic direction, leadership and financial success through effective management of payer and physician relationships, managed care operations, non-contracted and/or contracted payer negotiations, account management and network development. Possesses recognized leadership and strong organizational and analytical skills and will actively assist the Administration Department in promoting sound relationships with payers and physicians.

The Director of Hospital Contracting provides strategic direction, leadership and financial success through effective negotiation/implementation of reimbursement structures and payment models, management of payer and physician relationships, managed care partnerships and network development. Provides leadership in maintaining effective payer partnerships relationships with internal and external sources involved in the contracting and management process, participation in the development of contract language and negotiation strategy, in-depth financial analyses of contract performance, and making recommendations as to the desirability of canceling, renegotiations or extending contracts. Develop strategies to address ongoing pressure for reimbursement levels and work collaboratively with payers on new payment models and business opportunities.

Essential Duties:

• Lead the initiation, negotiation and execution of Hospital contracts with payers.

• Responsible for further development of a managed care / payer strategy to ensure that contracting efforts achieve the current and future goals of the Health System.
• Develop long-term strategies and tactics for managed care / payer contract negotiations.
• Develop contract structures that are appropriate (including the full range of reimbursement structures), consider cost, performance targets and make sense in relation to the size and scope of the contract.
• Analyze significant and unique contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations, and Organizational policies and business procedures.
• Promotes payer and physician collaborations and relationships.
• Develop strategies to address ongoing pressures for reimbursement levels, including those specific to academic medical centers, and work closely with appropriate physician leaders and departments to ensure their voice is heard.
• Monitor contract performance and other provisions to ensure compliance, identify problem areas and resolve disputes.
• Coordinates all Center of Excellence applications and site reviews
• Work closely with Hospital’s quality leadership team regarding Hospital quality incentive arrangements.
• Acts as a liaison to Keck Medical Center for all payer and managed care activities.
• Collaborates with Keck Medical Center to develop and implement Managed Care business plan.
• Assists hospital with evaluations of new programs or services.
• Performs other duties as assigned.

Required Qualifications:

• Req Bachelor's degree Business Administrative or related field
• Req 10 years 10 years of Managed Care experience in Payor/Hospital contracting

• Req Excellent negotiation skills and understanding of multiple reimbursement strategies
• Req Familiarity with Academic Medical Centers as well as the California payer market
• Req Possesses recognized leadership and strong organizational and analytical skills
• Req Able to actively promote sound relationships with payers and physicians.
• Req Must have strong verbal and written communication skills

Preferred Qualifications:

• Pref Master's degree Business Administrative or MPH related field

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $145,600.00 - $240,240.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.