Executive Director Managed Care Contracting - Crozer Keystone Health System

Senior Director, Managed Care Contracting – CKHS

The Senior Director, Managed Care Contracting, is responsible for the development, implementation, coordination and oversight of fee-for-service and value-based managed care contracting and related activities for CKHS and PHSPA, under the direction of the Senior Vice President. The position is hybrid and based at CKHS corporate headquarters in Chester-Upland, PA.
The Senior Director shall have primary responsibility to:
• Manage assigned portfolio of fee-for-service and value-based managed care payer contracts on behalf of CKHS hospitals, physicians and ancillary entities, in coordination with the operational leaders of each CKHS entity. Serve as primary liaison to assigned payers and operational areas within CKHS, with a focus on promoting proactive, professional and collaborative relationships, problem resolution and avoidance future of issues whenever possible.
• Develop payer strategies to ensure optimal contracting and operational outcomes, advocating on behalf of all CKHS providers as issues, opportunities or disputes arise. Monitoring payer activity with respect to network development, product strategies, payment policies and other relevant market intelligence.
• Negotiate assigned managed care contracts on behalf of all CKHS providers, including rates, payment methodologies, contract language and value based and shared /full risk payment programs, following all CKHS internal controls for contract review, approval and signature and in alignment with Crozer’s vision, goals and objectives. Support the SVP with contract negotiations by attending meetings, preparing relevant data and materials to support negotiations, serving as a subject matter expert for documentation and contract status updates.
• Manage implementation and ongoing management of completed contracts, including identification and tracking of critical contract and renewal dates, proper scanning, recording and filing of contract documents, dissemination and communication of information to internal constituents and education on new /revised terms and loading and monitoring of contracting systems (Apttus) as appropriate.
• Develop, implement and monitor contract implementation and on-going management of completed contracts, including identification and tracking of critical contract and renewal dates, proper scanning, recording and filing of contract documents, dissemination and communication of information to internal constituents and education/training to key constituents on new /revised terms.
• Proactively communicate and educate CKHS operational areas regarding contract changes, policy updates, etc., to ensure CKHS staff have information needed to successfully implement and operationalize agreements. Prepare and provide education, training materials and tools to CKHS providers and their staff regarding key managed care contract provisions, market trends and opportunities for improvement in support of facility goals and objectives, consistent with the mission and values of CKHS.
• Support billing, patient access, utilization management, revenue recovery, decision support, finance and budget department staff on managed care issues. Work collaboratively with CKHS management, operating unit departments and support areas such as patient access, central billing offices and medical management areas to improve functions across departments and with payers.
• Ensure CKHS providers and payers comply with all contract provisions, via tracking of performance through a variety of means, including audit of current performance via claims review, reports, etc.
• Monitor organizational changes that may impact contract performance and or will require payer notification, develop, implement and provide support for all notifications and communications in coordination with senior management.
• Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared shavings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies.

Candidates must possess the following qualifications:
• Bachelor’s degree in a related field with a minimum of 5-10 years of Director level or above managed care contracting in either a provider or payer setting required, Masters preferred.
• Excellent written and verbal communication skills required
• General knowledge and experience with managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared shavings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies.
• Excellent skills in Microsoft Office Excel (including advanced spreadsheet and formula manipulation), as well as in Word and PowerPoint. Access skills preferred but not required.
• Superior skills including organization, project management, implementation and analytical ability as well as the ability to coordinate and lead activities using a collaborative team approach.
• Ability to handle multiple projects and perform independently under tight deadlines with a focus on effective implementation, clear and consistent communication and follow-up.

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