Director, Managed Care Contracting

New York Metro Area, NY

Post Date: 01/25/2018 Job ID: 4563 Department: Financial Services

Title: Director, Managed Care Contracting

Location: New York Metro Area

Industry: Healthcare

Occupational Category: Finance

Hours: Full-time

Description: Hiring a Director, Managed Care Contracting for a professional Management Service Organization (MSO) and full-service provider credentialing firm. The Director, Managed Care Contracting reports directly to the Chief Executive Officer (CEO) and is responsible for the leadership and strategies for all Provider Services and assuring best in class quality of service for Providers. The Director, Managed Care Contracting will need to establish strong working relationships with key providers and work closely with all pillars within the organization.

  • Responsible for day to day operations in the department to ensure a strong positive relationship with contracted providers, vendors and plan members.
  • Manage the Provider Services Staff and develops and implements the strategy to best educate contracted providers about policies and procedures as well as special initiatives.
  • Oversees the development of documents and materials including: Directory, Orientation and Reference Guides, Newsletter and other provider correspondence.
  • Oversight of credentialing and re-credentialing of provider network
  • Establishes and evaluates criteria for vendor selection and performance.
  • Participates in selection of required products/services
  • Monitors performance of external resources (Providers, Vendors etc)
  • Integrates department services into the organization’ s strategic mission
  • Oversees provider services communications explaining benefits, policies and procedures
  • Oversee the quality of the provider relations department responses to inquiries and claims issues, participates in problem resolution with internal and external providers. Identifies and monitors provider issues and concerns, recommends solutions and follows up with provider during the process as well as communicates resolution to ensure problems have been resolved.
  • Assures accuracy of provider directory and network reports. Responsible for producing Quarterly and Annual HPN files, Hedis report on board certification, Part C reporting on network adequacy, and coordination of GeoAccess reports to meet network adequacy.

Education Requirements:
  • Bachelor’ s Degree in Health Care field related preferred

Experience Requirements:
  • Minimum of five years’ (5) experience in Medicaid/Medicare, Managed Care is required.

Desired Skills:
  • Management skills and a strong knowledge of Provider Relations policies and procedures.
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