Director – Managed Care

Location: Southeastern Indiana Medical Holdings, Inc.

Dept: 9102 Financial Services

Category: Management

Full Time, Days, 40 hours

Posted 7/25/2022

Requisition # 9706

What you need to know about this position:

  • Develops and maintains a network of relationships with third party and government payors, as directed by senior leadership.
  • Supports executive leadership in defining the strategy for each negotiation, including evaluation of strategic pricing, fee-for service, engagement in value-based contract structures, bundled arrangements, insurer product development, direct to employer arrangements etc.
  • Ensures that there is efficient and effective interaction between the health system and the government and third party payors as it relates to maximizing the yield of each contract.
  • Oversees and performs the necessary analytics during all phases of direct and payor contracting, including the development of complex models during negotiations and the ongoing analysis and reporting of payor performance.
  • Supports leadership in development of the infrastructure to support the contract lifecycle and system departments and service lines, development and implementation of management of payor relationships through joint operating committee meetings with the payors, development and oversight of a process to monitor contract yield and clinical performance to support contract negotiations, and development and implementation of processes to monitor changes to payor policies and legislation.
  • Reports directly to the Vice President, System Finance & Business Planning and uses best in class capabilities to support payor contracting that drives significant economic value throughout all phases of the contract lifecycle for the health system. Leads a small team of specialized staff.

What the successful candidate will bring to this position:

  • Bachelor's degree required in Finance, Healthcare, Business or a related field; Master's degree is preferred.
  • Extensive business experience in Payor & Direct Contracting, for both hospital and medical group operations, is required.
  • A minimum of 5 years of progressive leadership experience, in Payor & Direct Contracting management in a healthcare system, is required; or may consider an equivalent combination of education and experience.
  • Must demonstrate knowledge of current trends in health insurance and the managed care marketplace, as well as working knowledge of government and commercial risk sharing programs.
  • This position is eligible for partial remote/hybrid status consideration, allowing the leader to work from home for >50% of the time while also committing to work on-site in Columbus, IN as needed/requested by the organization.

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