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Director Of Managed Care Contracting - KMC in Weslaco, TX at Prime Healthcare Services Inc

Date Posted: 5/7/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Weslaco, TX
  • Job Type:
  • Experience:
    At least 7 year(s)
  • Date Posted:
    5/7/2019

Job Description

Responsibilities

The Director, Managed Care Contracting of Health Plan Operations is responsible for implementing Prime Healthcare Management's managed care contracting strategy on behalf of its owned and managed provider entities in a multi-state environment. Actively evaluate, negotiate and manage contractual relationships with health plans, hospitals/health care systems, medical groups/IPA’s, government programs and other Payors. Represent Prime Healthcare Management in the development of long term relationships with Health Plans and other provider entities. Travel as required to negotiate Agreements.
Qualifications

EDUCATION, EXPERIENCE, TRAINING

 

  1. A minimum of 7 years prior work experience in negotiating Commercial Insurance, Medicaid and, Medicare contracts; provider network management/development and/or management in a managed care or hospital setting is required.
  2. Ability to review contract language for financial, legal and operational impact and to ensure compliance with State and Federal Regulatory Agencies. Has the ability to develop contract language.
  3. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis, problem solving and project/time management essential.
  4. Requires a minimum of a Bachelor’s degree in related business/health/management field preferred or relevant prior work experience in Hospital and/or Provider Network Management.
  5. Demonstrated knowledge of
    1. The contracting process from preparation, negotiation and finalization;
    2. Contract language development and,
    3. Identification of key points requiring mediation.

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