UNITE HERE HEALTH

Director of Managed Care Contracting

US-IL-Aurora
4 months ago(8/25/2017 6:58 PM)
ID
2017-1378
# of Openings
1
Category
Healthcare Delivery
Company
UNITE HERE HEALTH

Overview

betterworkplaceuhh

 

 

Looking for a way to influence the health and healthcare of many?

 

If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

 

UNITE HERE HEALTH serves 100,000+ workers, 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

 

 

Key Attributes:

 

  • Integrity – Must be trustworthy and principled when faced with complex situations
  • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
  • Communication – Ability to generate concise, compelling, objective and data-driven reports
  • Teamwork – Working well with others is required in the Fund’s collaborative environment
  • Diversity – Must be capable of working in a culturally diverse environment
  • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
  • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

The Director of Managed Care Contracting is responsible for the managed care contracting for the Aurora based Plan Units. There are three parts to this role: First, the Director works with the Senior Director, HCD and the Regional Directors on Healthcare Delivery to develop and manage the strategic planning efforts for Healthcare Delivery as it relates to managed care contracting. Secondly, the Director is responsible for overseeing the management of the Aurora Healthcare Delivery Team who manage the day-to-day contractual relationships with the managed care vendors and providers. Thirdly, the Director is fully responsible for the Service Provider Resolution process of the Fund.

 

Responsibilities

  • Provides strategic direction, planning and management of the managed care vendor/provider contracting, in conjunction with the Senior Director, Healthcare Delivery and the Regional Directors.
  • Keeps informed on, negotiates and implements new strategies for innovative managed care vendor and provider contracting such as capitation, risk sharing, bundled payments, as well as unique contracting methodologies such as contracts with Health Centers, infusion centers, lab or radiology networks, etc.
  • Leads the administration, coordination, negotiation and the execution of all vendor and provider contracts and amendments.
  • Directly and indirectly supervises a team of Analysts and Managed Care Specialists (approx. 8 positions).
  • Oversees the management of the relationships with Aurora-based vendors and providers, identifying trends and issues and resolving problems in a timely manner.
  • Provides direction on analysis of the performance of contracts from utilization, financial and customer service standpoints.
  • Coordinates vendor issue resolution and implementation efforts with other Fund departments to include CAER, Claims, Legal and Underwriting.
  • Provides leadership and direction to staff.
  • Manages the Service Provider Resolution (SPR) process to include managing all related due dates and completing accurate SPRs in a timely manner.
  • Manages the Fund’s Service Provider Vendor Bid Process and Vendor Monitoring Program.
  • Perform other duties as assigned within the scope of responsibilities and requirements of the job.
  • Perform Essential Job Functions and Duties with or without reasonable accommodation.

Qualifications

Education and Certifications

  •  Bachelor’s degree in business, healthcare administration or a related field required.
  • Master’s degree in preferred.

 

Knowledge and Experience

  •  8 – 10 years’ or more experience in a healthcare, managed care, or insurance organization.
  • Requires an excellent understanding of, and has led, contracting efforts of the full range of managed care/healthcare models, including innovative models such as risk sharing arrangements and capitation, as well as more unique and/or direct provider arrangements including ancillary contracting efforts.
  • Strong working knowledge of current legislative requirements under ACA, COBRA, HIPAA, DOL, etc. as they related to health benefits, eligibility, payment and appeals.
  • Strong data and financial analysis experience.
  • Strong report writing and presentation experience.
  • Demonstrated strong leadership and interpersonal skills to lead others to achieve results in a team oriented environment.
  • Knowledge of working with unions or Taft Hartley Trust Funds a plus.

Essential Skills and Abilities  

  • Strong on initiative, innovation and motivation.
  • Strong problem solving and analytical skills.
  • Strong financial analysis skills
  • Strong verbal and written communication skills.
  • Strong project management skills.
  • Strong contract review and analysis skills.
  • Strong management/leadership skills.
  • Familiarity with Microsoft office products – Word, Excel, Power Point and Access.
  • Some travel required.

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