Director-Managed Care

Phoenix, Arizona, Position Summary The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PC, PCMG and PCCN contractual relationships. Education Bachelor`s degree in finance, health administration, or related field; OR five (5) years of managed care supervisory experience. (Required) Master`s degree (Preferred) Experience Ten (10) years managed care experience. (Required) Five (5) years supervisory experience. (Required) Three (3) years comprehensive managed care contracting for an integrated delivery system, ACO, multi-hospital system, or health plan. (Required) Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared savings and risk contracting, managed care regulations, quality metrics and risk contracting. (Required) Experience and/or familiarity with facility and professional billing systems and processes. Knowledge of CPT, HCPCS, facility revenue codes, and diagnosis codes. (Required) Certifications Health Care Financial Management Association (HFMA) certification. (Preferred) Special Skills In depth knowledge of managed care concepts, including finance, information systems, billing and claim adjudication, regulatory environment, and provider community. (Required) Excellent skills with Microsoft Office, especially Word, Excel, Outlook and PowerPoint. (Required) Strong verbal and written communication skills. Articulate and able to speak with credibility to small or large groups. (Required) Strong project management experience. (Preferred)