The System Director of Managed Care will serve as the managed care point person for certain Region(s) as Regional Subject Matter Expert (SME), while having System-wide accountability for numerous National Payers as assigned by VP Managed Care. Working with both corporate and regional staffs to ensure the accurate negotiation, implementation, administration and ongoing monitoring of managed care contracts and corresponding processes and procedures at the System and Regional level. Will have accountability to negotiate System managed care contracts and corresponding processes and procedures at the System level. May negotiate managed care contracts with regional payors as assigned by the System VP Managed Care. Will lead System negotiating team as assigned. Will work with System clinical quality department on quality metrics negotiated in contracts, which will impact future reimbursement. Will be accountable to work with System and Local Population Health and Clinical Integration staff to negotiate, implement, and monitor CIN and ACO managed care contracts. Position also has responsibility for provider related business development activity as assigned by VP Managed Care. A high degree of professionalism is required due to the interaction, both written and verbal, with both internal (regional) and external (payor) contracts.
BS in Business Administration or like degree with strong preference for Master's degree in Health Services Administration or MBA.
At least seven years of experience in health care or insurance organizations with experience in contract negotiation, physician interaction and network development.
At least seven years of management experience with a minimum of two direct reports.
At least seven years of experience leading large system negotiations in excess of $450M.
Excellent written and oral communication skills.
Excellent organizational skills.
Excellent training skills.
Knowledge of hospital, physician, and ambulatory contract modeling as well as reimbursement methodologies.
Accountable to lead numerous system-wide and state level payor contract negotiations.
Accountable to coordinate regional CIN/ACO managed care contracting initiatives (to include risk arrangements).
Accountable to lead Direct Employer contract negotiations.
Responsible for provider related business development activities as assigned by Vice President Managed Care (e.g. mergers, acquisitions, transactions with business development team).
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.