Director, Managed Care Contracting

Ou Health - Oklahoma City, OK

Full-time - Senior

Oklahoma City, OK

About the position

The Director, Managed Care Contracting is responsible for negotiating and managing managed care agreements for OU Health hospitals and physicians with third-party payers. This role involves analyzing, negotiating, and implementing new and renegotiated managed care agreements, developing payer strategies to enhance contracting and operational performance, and increasing net revenue through favorable contracts. The Director will also manage relationships with third-party payers and exemplify the mission, vision, and values of OU Health.

Responsibilities

• Negotiate and manage all managed care contracts with third party payers in consultation with OU Health key stakeholders
• Supervise, coach and mentor Manager, Managed Care Contracting
• Build and maintain positive ongoing relationships with all third-party payers to maximize market share and revenues
• Work closely with SVP, Managed Care and senior leadership to devise payer strategies
• Advance organization's contracting and reimbursement strategy through optimization of existing contracts
• Negotiate key legal terms and develop financial models to analyze payer proposals
• Coordinate feedback and approval of contracts from OU Health stakeholders
• Negotiate contract language and performance terms
• Lead implementation and coordination of new contracts
• Establish and participate in Payer joint operating committee (JOC) meetings
• Develop and maintain contract summaries including performance targets and measures matrix
• Monitor and manage payer compliance issues
• Monitor and analyze changes in payer programs and policies
• Work with Manager, Managed Care to coordinate credentialing/provider enrollment
• Participate in and report to various governing bodies
• Create strategic alliances with internal and external groups
• Supervise Manager, Managed Care Contracting Manager and facilitate staff recruitment and retention
• Perform other duties as assigned.

Requirements

• Bachelor degree in Business, Finance, Health Care, Economics or related field required
• 5 to 7 years of progressive leadership experience required
• Experience within an academic medical center, multi-hospital health system or managed care organization
• Demonstrated experience in healthcare analytics and medical economic modeling
• Direct experience leading negotiations and management of complex managed care contracts
• Strong knowledge of hospital and physician reimbursement methodologies
• Working knowledge of billing/coding terminology
• Procedural knowledge of hospital and physician practice accounts receivable management
• Strong industry knowledge of population health management activities
• Strong financial knowledge related to managed care reimbursement methodologies
• Ability to think critically and strategically
• Strong written and verbal communication skills
• Strong analytical and financial skills
• Excellent time and project management skills
• Microsoft Office Suite advanced proficiency, particularly MS Excel, Access and PowerPoint.

Nice-to-haves

• MBA, MHA or related Master's degree preferred

Benefits

• PTO
• 401(k)
• medical and dental plans
• comprehensive benefits package