Job Description

Job Type

Full-time

Description

Position Summary:

The Director, Managed Care is responsible for strategic partnerships with Managed Care Organizations, Post-Acute providers, and Health systems, including new business and revenue development through continued clinical integration and market expansion. Assists with business operations, audit/compliance, and analytical support. Advises senior management of business opportunities and strategies.

Essential Functions and Job Responsibilities:

• Leads and advances Strategic Partnerships for the Company, including clinical integration, enhancements in reimbursement, and innovative development, which includes negotiating alternative payment mechanisms, risk-sharing, and/or other reimbursement tactics to increase revenue.
• Provides guidance and direction to cross-functional business team members including Operations, Sales, Billing and/or Finance.
• Ensures timely and accurate setup and ongoing maintenance of contracts with contracted entities including, but not limited to payors, facilities, subcontractors, and other legal entities.
• Leads and assists with RFP’s.
• Solves complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.
• Serves as a subject matter expert on contract and reimbursement-related issues impacting the home medical equipment and supplies business and healthcare industries, particularly with a managed care and commercial reimbursement focus.
• Manages a portfolio of clients to identify and deliver on business opportunities and projects.
• Works with Audit and Compliance to ensure company stays in good standing with associated entities, regulations, and patients.
• Experience calling on the Post-Acute market (Medical Groups, At-risk programs, home based programs)
• Corporate Account and Business Development experience
• Health system experience
• Strategic partnerships
• Effectively evaluates and oversees TPA, as company moves forward with possible integration options.
• Develops and maintains working knowledge of current HME products and services offered by the company.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program and applicable company policies, procedures, and patient protocols.
• Performs other related duties as assigned.

Management/Supervision:

• Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding, and providing comprehensive training and regular feedback.
• Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
• Establishes annual goals and objectives for the department based on the organization’s strategic goals.
• Responsible for achieving organizational performance and retention goals, including timely completion of performance evaluations.

Requirements

Competency, Skills, and Abilities:

• Proven leadership skills
• Ability to handle complex contract negotiations.
• Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies
• Independent thinker and decision maker
• Strong analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication
• Strategic business partner
• Proficient computer skills and knowledge of Microsoft Office specifically Excel
• Ability to prioritize and manage multiple projects.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.

Education and Experience Requirements:

• Bachelor’s degree in relevant discipline from an accredited college required.
• Seven (7) years of relevant work experience required in contracting, credentialing, or network management.
• Five (5) years of management experience in related position is preferred.
• Valid and unrestricted driver’s license in the state of residence