DIR MANAGED CARE
H. Lee Moffitt Cancer Center
ID: 7126375 (Ref.No. hlj_43487)
Posted: February 23, 2023
Application Deadline: Open Until Filled
• This position is responsible for planning and directing the activities of the Managed Care Department to support the Cancer Center's strategic vision for managed care. He/she will oversee all Cancer Center managed care contracts including hospital, employed physician group, delegated credentialing, and Center of Excellence agreements (BMT and Car-t). Under the leadership of the Vice President of Payer Strategies, the Director of Managed Care is responsible for negotiating the Cancer Center's fee for service contracts and alternative payment model arrangements including bundled payments, shared savings, and risk contracts. The Director of Managed Care actively participates in Moffitt's strategic planning initiates to provide payer insights for the future growth of the Cancer Center. The Director of Managed Care actively supports the Payer Strategy responsibilities as part of strategic partnerships.
• Developing the negotiating posture related to contracts terms and conditions for each negotiation. This includes development and communication of the negotiating strategy as well as the execution by the managed care team. The Director is responsible for advancing pricing strategies and terms that support the strategic initiative of the organization. The Director will design proactive initiatives with third parties that optimize finances and opportunities for greater efficiencies.
• The Director is responsible for addressing health plan policies and trends across the revenue cycle including patient access, financial clearance, and patient financial services departments. He/she ensures that the Cancer Center's managed care contracts are performing as intended. The Director of Managed Care facilitates regular meetings with health plan representatives to foster strong working relationships and provide a forum for Cancer Center departments to solve problems. Disputes related to health plan policies or changes that impact the Cancer Center are managed under the leadership of this individual.
The Ideal Candidate will have:
•Preferred six (6) years' experience in healthcare revenue cycle, payment integrity process, or health plan claims/policy experience. Demonstrated track record of success in a similar role with experience directing and managing all aspects of third party contracting requirements within complex health system. Ideally demonstrated experience in strategy design, reimbursement analytics and managed care contract negotiations for hospitals/physicians or payer equivalent.
•Preferred three (3) years' experience with Oncology and/or cancer related field especially as it related to reimbursement and payer emerging issues. Demonstrated success in building a pricing strategy with advanced terms/conditions that meet the needs of a complex, tertiary care facility. Including strategies related to advancing price transparency, it's impact and implementation.
Credentials and Qualifications:
•Bachelor's Degree in business or related field.
•Minimum of ten (10) years of managed care experience, healthcare finance, strategy, or healthcare management; including six years of progressively challenging experience in managed care in the health care provider or payer settings.
•Minimum of six (6) years' experience with demonstrated success in executing successful negotiations with appropriate communications, analytics, and results.
•Minimum of four (4) years demonstrated skills in areas supervision, management, written and verbal communication, judgment, problem solving, and presentations.
Mission To create a Moffitt culture of diversity and inclusion as we strive to contribute to the prevention and cure of cancer. Vision Moffitt Cancer Center is recognized as the model wherein the diversity of our employees and communities is valued and supported as essential components to contributing to the prevention and cure of cancer. The cancer center is an equal opportunity employer. It is the policy of the cancer center to prohibit unlawful discrimination and harassment of any type and to afford equal employment opportunities to workforce members and applicants, regardless of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, disability, genetic information, veteran’s status or any other characteristic protected by federal, state or local law.