Director, Risk Contracting & Management
New York Metro Area NY
Title: Director, Risk Contracting & Management
Location: New York Metro Area, NY
Occupational Category: Administrative/Operations
Description: Hiring a Director, Risk Contracting & Management for a managed care organization located in the New York City area.
- Develop relationships with Senior Executives and leadership.
- Assist VP in renegotiation of all financial and contractual terms during renewal. Develop financial proposals for renewal including supporting documentation and analyses.
- Document requested revisions to contractual terms and rationale for requested revisions.
- Develop and manage new forum for key providers and partners to share best practices on effectively facilitating costs.
- Collaborate with medical management team to develop forum, solicit participation, and set an agenda.
- Manage the team that provides service support for all value-based arrangements, including the research and resolution of claims payment and utilization management issues, provider appeals, etc.
- Determine Root causes to properly implement corrective actions to resolve these issues.
- Monitor financial and utilization performance.
- Analyze performance against internal and external benchmarks.
- Identify opportunities for improvement.
- Implement new Governance structure
- Actively participate in all levels of Governance Committees.
- Develop and maintain reporting packages.
- Responsible for overseeing the creation and ongoing monitoring of performance dashboards for value-based groups.
- BA/BS Required
- Master’s Degree (MBA, MPH) preferred
- 8-10 years relevant experience in provider contracting, network management, medical management, or other relevant health plan provider or government experience.