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Director, Managed Care

Job Description


Job ID: 1198966
Employment Status: Full-Time
More Information:

Boone Hospital Center is a 394-bed full service hospital located in Columbia, MO. It is a regional referral center located in the center of the state. The hospital provides progressive healthcare programs, services, and technology to people in 26 mid-Missouri counties. Although the hospital is full service, areas in which Boone Hospital Center excels are cardiology, neurology, oncology, surgical, obstetrical services, and numerous other specialties. The hospital maintains a 24-hour emergency center with hospital-based ambulance service and a helipad for incoming emergency air transportation.  Recognizing its excellence in nursing care, Boone Hospital Center has been certified as a "Magnet Hospital" by the American Nurses Credentialing Center.
 


Overview


Role Purpose

In conjunction with the Vice President, Managed Care, execute the payer contracting strategy which has been designed to optimize clinical, financial and operational performance by BJC HealthCare. Direct day-to-day departmental operations that support BJC wide initiatives, including value based contracting strategies, by collaborating with HSOs, Center for Clinical Excellence (CCE), BJC Medical Group (BJCMG) and Revenue Cycle Management (RCM). Collaborate with internal and external partners on managed care issues to ensure that BJC continues to be recognized nationally as a leader in the healthcare industry.


Responsibilities

  • Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
  • Develop and execute Managed Care strategies that preserve and enhance BJC’s financial viability, promote growth and create broad access to BJC Affiliates. Collaborate with system leaders to prioritize and execute strategies. Provide financial analyses to support strategic initiatives and leverage resources.
  • Responsible for overseeing the strategic planning, successful negotiation, execution and monitoring of performance for all BJC managed care contracts, including pricing strategies, methodologies, alternate payment models and favorable contract language protections. Lead all aspects of contract negotiations with the health plans from the start through successful completion of the Agreement. Review and develop contract language that protects revenue and improves administrative functions. Direct financial analyses to support contract negotiations including developing the financial strategy and targets, setting the time line for the negotiations, overseeing the development of the financial model and rate proposals, and communicating to leadership. Collaborate with the Center for Clinical Excellence (CCE), Hospitals Service Organizations (HSOs) and BJC Medical Group leaders around pay for performance/shared savings arrangements, including developing metrics, targets and performance reports. Collaborate with the HSO’s finance departments to identify opportunities for improvement around contract rates and methodologies to meet their operating margin needs. Ensure that contracts are loaded timely and accurately in the contract modeling system to ensure correct payment of services.
  • Provide support for BJC wide initiatives around value based contract models, including executing contracts, providing data analytic and financial support and participating on system focused committees. Oversee the development of report packages that support for various value based arrangements. Responsible for the accurate and timely reconciliation process for CMS bundles, ensuring that the correct gain share payouts are distributed to the appropriate individuals. Provide analytical and reporting support for the pay for performance/shared savings programs in order to monitor performance and improve outcomes.
  • Continuously monitor the competitive environment to understand managed care trends impacting current and future healthcare business and reimbursement models in order to identify opportunities around payer activities, payment policies and product development. Establish network of relationships with other providers, payers, and national organizations in order to create a sharing and learning environment.
  • BJC has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.

  • Minimum Requirements

     

    Degree

  • Bachelor's Degree
  • - Accounting/Finance/related

     

    Experience

  • 2-5 years
  •  

    Supervisor Experience

  • 2-5 years

  •  

    Preferred Requirements and Additional Job Information

     

    Degree

  • Master's Degree
  •  

    Licenses & Certifications

  • CPA

  • Benefits Statement

    Note: not all benefits apply to all openings

    -  Comprehensive medical, dental, life insurance, and disability plan options
    -  Pension Plan*/403(b) Plan
    -  401(k) plan
    -  Tuition Assistance
    -  Health Care and Dependent Care Reimbursement Accounts
    -  On-Site Fitness Center (depending on location)
    -  Paid Time Off Program for vacation, holiday and sick time

    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center


    Legal Statement

    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

     

    Equal Opportunity Employer