Director, Managed Markets - Southwest Division
Sonic Healthcare USA

Job Info

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Job Functions, Duties, Responsibilities and Position Qualifications:

Quality is in our DNA, is it in yours?

Clinical Pathology Laboratories (CPL) has an exciting opening for a Director, Managed Markets for our Southwest Division.

(This is not a remote opportunity. Final candidate will be required to be in Austin, TX)

The Director of Managed Markets leads the managed care efforts for the Southwest division. Responsible for focusing on managing and optimizing relationships with payers and familiar with various concepts, practices, and procedures necessary to meet the division's goals. Responsibility also includes working independently to manage the implementation of all contractual changes within several systems, timely communication of the financial terms that affect department reimbursements, and contract maintenance.

Essential Job Duties:

• Assists with managing the day-to-day operations of the Managed Markets Payer Contracting.
• Establishes and maintains strong relationships with payers, including negotiation and collaboration on contract terms, pricing, reimbursement, and formulary placement for products or healthcare services.
• Leads efforts to secure optimal market access for products or services by understanding payer requirements, coverage policies, and reimbursement processes.
• Advises the Revenue Cycle Management team on emerging trends and methodologies and shifting requirements in managed markets contracting, payer relations, and legal issues.
• Utilizes analysis for feedback on contract renewals, renegotiations, or termination. Makes recommendations regarding participation or non-participation with new or existing agreements.
• Monitors and analyzes market dynamics, payer policies, and healthcare regulations to identify potential opportunities, risks, and changes in the managed care landscape. This information helps inform strategic decision-making and market access initiatives.
• Conducts educational programs and provides training to Revenue Cycle staff and stakeholders on managed care trends, payer policies, and market access strategies.
• Develops and implements strategic plans for managed markets for other reimbursement & profitability endeavors with subcontract arrangements, government programs, pay-for-performance initiatives, and value-based agreements.
• Acts as a liaison with physician practices, hospitals, other affiliated organizations, and managed care organizations regarding issues pertaining to managed markets
• strategies with broader business objectives and ensure seamless execution.
• Performs other related duties as assigned.

Qualifications:

• Bachelor's Degree required Master's Degree desirable.
• Minimum of five (5) years of managed markets or health plan experience.
• Strong understanding of Managed markets: IPA, ACA, ACO, PHO, MSO (HMO, PPO, and Government programs).
• Strong understanding of hospital, physician and ancillary reimbursement methodologies. Along with VMP (Value-based Medicine)
• Requires expertise in State and Federal healthcare regulatory and reimbursement laws, including the False Claims Act, and their implementing regulations.

Skills and Abilities:

• Excellent verbal and written communication skills
• Strong interpersonal, presentation, and analytical skills
• Strong working knowledge of computer spreadsheet programs and database programs such as Access and CRM Programs
• Ability to work in a team-based environment and leverage the diverse strengths and skills of the team members to achieve shared objectives
• Knowledge of research principles, concepts, practices, and methodologies.
• Ability to give clear direction and produce consistently outstanding results
• Ability to work independently, stay organized, and manage competing priorities
• Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook

Scheduled Weekly Hours:
40

Work Shift:

Job Category:
Administration

Company:
Clinical Pathology Laboratories, Inc.

Excited about a career with a company that exemplifies its core values and offers a great total rewards package? Apply Now!

• Competitive wages
• Medical, Dental, Vision, Life and AD&D, Short and Long Term Disability
• 401k Savings Plan and Employer Match
• Work-life balance, including Paid Time Off and Paid Holidays

Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This job has expired.