Cardinal Health
Director, Managed Care - Navista
Cardinal Health, Carson City, Nevada, us, 89702
Cardinal Health Director, Managed Care - Navista Carson City, Nevada
At Navista, our mission is to empower community oncology practices to deliver patient-centered cancer care. Navista, a Cardinal Health company, is an oncology practice alliance co-created with oncologists and practice leaders that offers advanced support services and technology to help practices remain independent and thrive.The Director, Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible to implement strategic initiatives related to payer contracts. The Director, Managed Care contributes to practice growth and profitability by providing contracting expertise to existing and new contractual relationships; and providing subject matter expertise, guidance, and direction regarding managed care contracts.This role’s primary focus is to work diligently to ensure optimal reimbursement for physician services and physician satisfaction as it relates to managed care contracts and operations. This position is responsible for administrative, strategic, business development, and contracting activities related to the Managed Care environment. They will be a seasoned leader and advisor, with proven experience supporting physicians in oncology to identify and realize payer specific reimbursement opportunities.This position reports to the VP, Operations for Navista.This is a remote, work from home role with travel up to 50%.ResponsibilitiesDevelop and manage a team of managed care and credentialing specialists, vendors, and consultants. Oversee practice managed care and credentialing staff.Periodically assess local and global market reimbursement rates for clinical procedures. Develop and communicate with physician and executive leadership teams, payer specific Managed Care analytics and reports on a regular basis.Directly responsible for practice’s managed care strategy development and execution. Develop strategies and action plan to implement opportunities for rate improvements.Monitor relevant practice specific payer trends and compare to global and/or market trends. Advise physicians and operations leadership on reimbursement risks as it relates to specific procedures and codes.Direct the daily operations of managed care contracting and payer relations to include contracting activities such as focusing on rate strategies, maintaining strategic internal and external relationships, evaluating contracts and related contractual relationships.Negotiate contract renewal terms and develop and implement new contracts based on contract goals and parameters.Create and implement new rate structures that enhance reimbursement when appropriate.Lead proactive contract renewal by working closely with operations, revenue cycle and finance leadership to develop contract proposals based defined strategies, goals, and objectives.Provide managed care consulting and leadership relative to business direction, strategy and network positioning as they relate to payer reimbursements.Disseminate relevant contract details to all relevant departments (such as patient access, registration, business office, finance, practice operations etc.) to facilitate contract administration and execution.Support clinic and admin departments in understanding operational issues as they relate to specific contracts and patient populations (e.g., collections, prior authorizations, referrals, etc.).Direct the preparation and distribution of managed care reporting for senior Navista and physician leadership demonstrating financial analysis of current and proposed managed care contract performance and utilization.Provide input to finance department with respect to contract performance analysis and monitoring.Works effectively with multiple practice departments, external payers, hospital and health systems, CIN’s, IPA’s, etc. to develop and negotiate contract opportunities.Support managed care strategy and contracting activities related to special projects, including new practice acquisitions and addition of new services.Provide leadership and support to payer issues and escalations meetings and develop and maintain appropriate relations with managed care payors.QualificationsBachelor’s degree in business, healthcare administration, or other related field required; master’s degree preferred.12 + experience in a contracting related field within a community physician office environment preferably oncology or a managed care related entity such as an HMO, ACO, clinically integrated network preferred.Must possess experience with negotiating managed care/health plan contracts, administering and implementation of contracts.Must have experience with facilitating billing and claims issues attributed to payor contracts.Demonstrate a high level of knowledge of health care delivery systems, the local and national health care environment, and the dynamics of hospital/physician relations.Ability to determine appropriate course of action in complex situations.Outstanding organizational and time management skills.Excellent interpersonal and leadership skills.Great communication and presentation skills.Problem-solving mindset.Ability to travel as needed (up to 50%).Anticipated salary range: $102,000 – $182,005Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.Medical, dental and vision coveragePaid time off planHealth savings account (HSA)401k savings planAccess to wages before pay day with myFlexPayFlexible spending accounts (FSAs)Short- and long-term disability coverageWork-Life resourcesPaid parental leaveApplication window anticipated to close: 09/05/2024. If interested in opportunity, please submit application as soon as possible.The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background.To read and review this privacy notice click
here .
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At Navista, our mission is to empower community oncology practices to deliver patient-centered cancer care. Navista, a Cardinal Health company, is an oncology practice alliance co-created with oncologists and practice leaders that offers advanced support services and technology to help practices remain independent and thrive.The Director, Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible to implement strategic initiatives related to payer contracts. The Director, Managed Care contributes to practice growth and profitability by providing contracting expertise to existing and new contractual relationships; and providing subject matter expertise, guidance, and direction regarding managed care contracts.This role’s primary focus is to work diligently to ensure optimal reimbursement for physician services and physician satisfaction as it relates to managed care contracts and operations. This position is responsible for administrative, strategic, business development, and contracting activities related to the Managed Care environment. They will be a seasoned leader and advisor, with proven experience supporting physicians in oncology to identify and realize payer specific reimbursement opportunities.This position reports to the VP, Operations for Navista.This is a remote, work from home role with travel up to 50%.ResponsibilitiesDevelop and manage a team of managed care and credentialing specialists, vendors, and consultants. Oversee practice managed care and credentialing staff.Periodically assess local and global market reimbursement rates for clinical procedures. Develop and communicate with physician and executive leadership teams, payer specific Managed Care analytics and reports on a regular basis.Directly responsible for practice’s managed care strategy development and execution. Develop strategies and action plan to implement opportunities for rate improvements.Monitor relevant practice specific payer trends and compare to global and/or market trends. Advise physicians and operations leadership on reimbursement risks as it relates to specific procedures and codes.Direct the daily operations of managed care contracting and payer relations to include contracting activities such as focusing on rate strategies, maintaining strategic internal and external relationships, evaluating contracts and related contractual relationships.Negotiate contract renewal terms and develop and implement new contracts based on contract goals and parameters.Create and implement new rate structures that enhance reimbursement when appropriate.Lead proactive contract renewal by working closely with operations, revenue cycle and finance leadership to develop contract proposals based defined strategies, goals, and objectives.Provide managed care consulting and leadership relative to business direction, strategy and network positioning as they relate to payer reimbursements.Disseminate relevant contract details to all relevant departments (such as patient access, registration, business office, finance, practice operations etc.) to facilitate contract administration and execution.Support clinic and admin departments in understanding operational issues as they relate to specific contracts and patient populations (e.g., collections, prior authorizations, referrals, etc.).Direct the preparation and distribution of managed care reporting for senior Navista and physician leadership demonstrating financial analysis of current and proposed managed care contract performance and utilization.Provide input to finance department with respect to contract performance analysis and monitoring.Works effectively with multiple practice departments, external payers, hospital and health systems, CIN’s, IPA’s, etc. to develop and negotiate contract opportunities.Support managed care strategy and contracting activities related to special projects, including new practice acquisitions and addition of new services.Provide leadership and support to payer issues and escalations meetings and develop and maintain appropriate relations with managed care payors.QualificationsBachelor’s degree in business, healthcare administration, or other related field required; master’s degree preferred.12 + experience in a contracting related field within a community physician office environment preferably oncology or a managed care related entity such as an HMO, ACO, clinically integrated network preferred.Must possess experience with negotiating managed care/health plan contracts, administering and implementation of contracts.Must have experience with facilitating billing and claims issues attributed to payor contracts.Demonstrate a high level of knowledge of health care delivery systems, the local and national health care environment, and the dynamics of hospital/physician relations.Ability to determine appropriate course of action in complex situations.Outstanding organizational and time management skills.Excellent interpersonal and leadership skills.Great communication and presentation skills.Problem-solving mindset.Ability to travel as needed (up to 50%).Anticipated salary range: $102,000 – $182,005Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.Medical, dental and vision coveragePaid time off planHealth savings account (HSA)401k savings planAccess to wages before pay day with myFlexPayFlexible spending accounts (FSAs)Short- and long-term disability coverageWork-Life resourcesPaid parental leaveApplication window anticipated to close: 09/05/2024. If interested in opportunity, please submit application as soon as possible.The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background.To read and review this privacy notice click
here .
#J-18808-Ljbffr