Medical Practice Other - Baystate Health

Req#: R15948
Category(s): Allied Health Clinical Professional, Medical Practice Other
Full Time / Part Time: Full-Time
Shift: First

Baystate Health, western Massachusetts’s premier healthcare provider, and home to Baycare Health Partners, ​a physician-hospital organization (PHO), Baycare® is seeking a Director of Managed Care. This is a remote position.

The Director of Managed Care position will execute contract strategies and manage the activities of the Contract Management function of Baystate Health and members of Baycare Health Partners (BHP).

In addition, the Director works closely with other Baystate Health and BHP departments to communicate identified problems and issues that arise within the contracting framework of provider networks. Must have a solid understanding of provider fee schedules, reimbursement methodologies (facility, professional, value-based, and otherwise), provider contract strategies, as well as industry standards for provider payment policies. The Director will collaborate with the Directors of Revenue Cycle, the Director of Clinical Management, and the VP of Managed Care to develop and implement all Corporate and Department strategies.

This position will strengthen the focus of the Managed Care contracting team on consistent pricing, timely renewals, oversight of reimbursement trends, and membership growth tied to our provider partners. In addition, this position will support the BH and BHP staff effort to keep Managed Care activities in the departments and functions throughout BH and BHP and drive the contracting strategies developed by the VP of Managed Care.

The Director reports to the VP of Managed Care of Baycare Health Partners and Baystate Medical Practices and directly oversees the activities of all BH managed care contracting and administrative functions and BHP contracting functions.

Qualifications:

Seven or more years of progressive and responsible experience in healthcare management with a thorough understanding of the healthcare market and the needs/concerns of healthcare providers.

Excellent working knowledge of managed care contracting, including the fundamentals of contract design, variations in provider compensation arrangements including capitation, and a working knowledge of hospital reimbursement. Requires experience with advanced financial and analytic models.

Demonstrated ability to communicate effectively with physician leaders and high-level hospital administrators, in addition to excellent negotiation skills.

Demonstrated negotiation skills and the ability to formulate coherent strategies in a rapidly changing provider environment. In addition, a high level of diplomacy is necessary to anticipate, recognize and deal effectively with politically sensitive issues.

Requires sensitivity regarding network issues and the political instincts to deal effectively with conflicting interests.

Requires the ability to understand the nuances of the Health Plan’s numerous product lines and the unique operational and financial features associated with each of these products.

Requires a solid personal presence that will engender confidence among providers.

Strong sales persuasion skills and the ability to communicate complex qualitative information in a variety of provider settings.

Must be able to work cooperatively as a team member and promote the development of strong work relationships with various departments throughout the company.

Bachelor's Degree required.

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Bachelor of Arts (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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