Regional Director, Medicare Advantage and Managed Medicaid Provider Network Contracting Details

Regional Director, Medicare Advantage and Managed Medicaid Provider Network Contracting

MultiPlan Inc. - Irving, TX

Employment Type : Full-Time

JOB SUMMARY:

This position is responsible for the overall management of a team of contractors in assigned territory or territories within a region. This job is also responsible for working with management to define and aggressively execute regional strategies based on market trends and client expectations. In addition, this job is responsible for the continuing evaluation of the region's network in terms of penetration and discounts.

JOB ROLES AND RESPONSIBILITIES:

1. Assist management in the identification and development of contracting priorities for assigned territory to support Network Development contracting initiatives.

2. Execute regional contracting objectives through team members in a timely and effective manner.

3. Ensure the establishment and maintenance of superior relationships with providers in assigned territories.

4. Facilitate education and training opportunities for contract team members including direct one to one training that produces a full understanding of products, demonstrated knowledge and use of systems, and a command of negotiations related to contractor's position.

5. Oversee entire negotiation and contract development processes for assigned staff, including but not limited to, reviewing and approving language; reimbursement and contract preparation prior to submittal to management for final approval; and participation in complex provider negotiations with contract team members and using such situations as learning experiences.

6. Partner with HCE to conduct financial analyses and monitoring of marker trends to identify, develop, and implement competitive reimbursement.

7. Work with Regulatory Department to ensure compliance with federal and state regulations for existing and proposed product portfolio.

8. Participate in active dialogue with sales and account management on a scheduled basis to assess network adequacy and to anticipate client expectations of the network.

9. Work with and facilitate open communication with all departments to ensure company and department goals are met.

10. Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution.

11. Select, develop, evaluate, mentor, and manage staff to ensure regional network growth, development of a productive team of contractors, and provision of a career path within the region and company.

12. Collaborate, coordinate and communicate across disciplines and departments.

13. Ensure compliance with HIPAA regulations and requirements.

14. Demonstrate Company's Core Competencies and values held within.

15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

The incumbent significantly influences the execution and achievement of regional contracting goals, objectives, and results. The management of day-to-day operations focuses on operating decisions at the major project or functional level within assigned territories. An incumbent operates with considerable latitude for unreviewed decisions, uses an extensive range of knowledge to complete job responsibilities, and participates in planning processes at major project and departmental level. This job requires ongoing collaboration with counterparts in the organization to ensure appropriate operational support and coordination of objectives. The incumbent utilizes in-depth knowledge, advanced problem-solving skills and an understanding of company priorities to achieve results and handle non-routine issues by following broad policy or precedent. Work leadership is direct and involves hiring, discipline, performance management, coaching, mentoring, etc. The incumbent will possess the skills necessary to strategize, construct and negotiate complex financial rate structures, and contract language, and can demonstrate successful negotiations that require this skill set.
JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum Bachelor's degree in a related field, or HS Diploma (or GED) and four (4) years of experience related to network development

• MBA or MHA in health-related field preferred

• Minimum 10 years' experience in provider contracting and network development including at least 5 years' operational management experience as well as experience in financial analysis and project management, successfully negotiating complex financial rate structures and contract language.

• Successful management of multiple competing priorities.

• Minimum 5 years' experience in managing people

• Required licensures, professional certifications, and/or Board certifications as applicable

• Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance

• Knowledge of provider organizations and operations applicable to assigned focus

• Communication (written, verbal and listening), business acumen, analytical, negotiation, organization, strategic, multitasking and prioritization skills

• Ability to demonstrate successful negotiations by possessing skills necessary to strategize, construct and negotiate complex financial rate structures and contract language.

• Ability to elicit trust and credibility as well as interface with all levels of the organization

• Ability to build relationships with internal and external customers

• Ability to use computer software, hardware, and peripherals applicable to role

• Ability to formulate the solution and involve others in solving issues

• Ability to understand relationships and structures of providers and competitors

• Ability to be comfortable with and to manage in-person client interface

• Ability to effectively communicate the MultiPlan Value Proposition.

• Commitment to highest standards of quality and integrity

• Up to 50% travel within assigned region, primarily to meet with providers on a frequent basis and, at times, with little advance notice, as well as travel to attend Company sponsored meetings and appropriate professional conferences

As an Equal Opportunity Employer, MultiPlan will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.