Position Summary
The Executive director of the MSO coordinates Clinicas’ policies, goals, and objectives related to contract language and rate pricing, negotiation strategy, planning and execution, revenue reconciliation, and payer and provider network relationship management. The executive director provides strategic leadership, financial and administrative oversight of the provider contracted network as well as both managed care and non-managed care contracting and operations with commercial, Medicare, and Medicaid payers on behalf of the organization and other related ventures.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The Executive Director of the MSO is responsible for performing the following duties:
- Provide strategic oversite of the MSO managed care subsidiary of Clinicas del Camino Real.
- Supervises the Director of Medical Management and Director of Managed Care and Network Operations.
- Structure, hire, lead, and develop a team focused on the managed markets business with the intent of delivering broad payer coverage while exceeding revenue goals
- Work closely with Utilization Management and MSO leaders to identify any gaps in provider network. Pursue and negotiate consequent contracts.
- Establish and maintain positive, appropriate relationships with market payers and network providers. Utilize communication and organizational skills to work collaboratively and credibly to achieve common objectives.
- Work collaboratively with internal stakeholders including Operations, Finance/Billing, Utilization Management, and Credentialing to define and achieve common payer strategy and reimbursement objectives.
- Develop and execute communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
- Coordinate financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers, adverse trends, etc., and make appropriate recommendations or conclusions.
- Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback regarding financial and/or operational issues with payers.
- Responsible to ensure contract language is in compliance with Federal, State, Industry and Clinicas’ standards and guidelines.
- Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
- Bachelor’s degree required; graduate degree in a related field such as public health or public policy preferred
- 7+ years professional experience in Managed Care or Contracting
- 3+ years management experience with a managed care team
- Previous experience in the provider industry or contract management is highly preferred.
- Experienced working with payers Experience and knowledge of federal and state legislative environments and regulatory processes to dissect complex scenarios and are able to bring issues to swift resolution.
- Expert in medical billing, third party payers and patient interface, patient privacy and confidentiality paramount.
- Follow payer policy activities on coverage and payment technology processes and practices
- Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, provider networks, hospitals and health insurance benefit plan designs.
- Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies.
- Highly developed communication, presentation, and organizational skills.
- Strong selling and closing skills.
- Experience assessing problems & implementing solutions.
- Reliable transportation is required.
- Bilingual English/Spanish desirable.