Managed Care Regional Director
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Job Description
Managed Care Regional Director leading managed care contracts and relationships at CSI Pharmacy. Responsible for coordinating with health plans and ensuring favorable contract terms.
Responsibilities:
- Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
- Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
- Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payers and providers
- Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
- Responsible for coordination and communication between managed care and other interested party departments and leadership
- Responsible for developing new and existing relationships with medical and pharmacy plans to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
- Oversight of payer credentialing
- Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
- Communicates with respective payers related to trends and compliance with contract parameters
- Consistently represents the company in a professional manner
- Maintain effective working relationships and cooperate with all personnel in the Company
- Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies
Requirements:
- Bachelor’s Degree preferred or equivalent experience
- At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
- Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience
- Preferred experience in managing, analyzing, and reporting denials and appeals.
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