Director, Hospital Contracting (Regional)

 

Summary

 

Under the general direction of the Reg VP Network Management, this position plans, directs and controls the activities related to Facility Contracting (for both Rochester and Southern Tier regions) to assure that the Corporations act as prudent purchasers of services by developing, maintaining, and enhancing contractual and payment relationships with all providers.

 

Essential Responsibilities/Accountabilities

 

· Develops and implements reimbursement and negotiation strategies for facility providers.

· Develops and maintains respectful relationships with providers. 

· Analyzes needs for various networks and recruits providers for these multiple networks.

· Develops and maintains legal contract templates and amendments and obtains appropriate and timely signoff from internal legal and risk management areas, outside regulatory agencies such as the DOH, Health Plan, HCFA, and Medicaid.

· Develops, maintains, and enhances processes for contract management functions, such as identification of providers, mailings of contracts, obtaining signatures, credentialing, obtaining appropriate licensure information and contract renewal terms and timeframes.

· Will work with other internal areas in developing best practice principles around contract negotiations and reimbursement.

· Will identify opportunities for reducing administrative or benefit expense.

· Is accountable for price management functions for all products and will liaison with Utilization Management and Medical Affairs to ensure appropriate strategies are developed and implemented relative to benefit expense management.

· Provides direction and supervision for direct and indirect reports.  Provides routine feedback on development, skills, and performance measurements.  Provides a succession plan and works toward identifying and mentoring high potential employees.  Will hire, train and counsel as appropriate and will ensure that Corporate policies are followed.

· Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.

· Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

· Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.

· Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

· Regular reliable attendance is expected and required.

· Performs other functions as assigned by management.

 

Minimum Qualifications

 

· Bachelors Degree a requirement.  Masters Degree preferred. 

· Must have experience in finance, actuarial, and/or negotiations. 

· Must have excellent communication and negotiation skills.

· Must be able to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders, and other providers of health and health related services and equipment.

· Must have a current and thorough understanding of health care, financial models, physician organizations, contracts, and the Corporations’ products, and must be able to effectively discuss these issues with others.