POSITION SUMMARY: Responsible for successful leadership with Managed Care Contracts to achieve company objectives. Develop and implement innovative, strategic plans with respect to Managed Care reimbursement. Act as signature authority for managed care contracts and assure financial viability of agreements. Position the Genesis for current and future financial success with emphasis on preferred provider relations. Meet or exceed budgetary census and reimbursement goals.
1. Initiate and maintain relationships with Genesis executive and divisional management as well as corporate level leadership at payors.
2. Oversee the finalization of all MCO contracts focusing on financial reimbursement structure of managed care agreement prior to renewal or executing new signature.
3. Participate in development of budgetary targets related to managed care census and reimbursement as well as strategic plans.
4. Work closely with Managed Care Services Business Development staff to implement innovative business strategies, assist with negotiation tactics for rates, and create incentive options with health plans. This includes but not limit to pricing/rates, satisfactory Cost of Living Adjustments terms, risk arrangements like shared savings/pay for performance, and other innovative financial incentive models.
5. Create value added propositions to the plans and payors to support relationship development (ex. HEDIS, risk scoring, etc).
6. Lead company to implement strategies to maximize both short-term profit contribution and longer-term competitive position as the premier post acute provider.
7. Seek opportunities to competitively differentiate Genesis' services from other providers by identifying new services needed and developing new services to meet the market changes.
8. Design and implement such programs as necessary to ensure that Genesis is highly visible and favorable as differentiated by managed care organizations, insurance companies, self-insured employers, UR and case management companies, etc.
9. Assure parameters created with any special reimbursement model or programs noted above limit risk to Genesis while maximizes financial and clinical return.
10. Establish systems to track and monitor successful implementation of contracts. Interface with other administrative areas and staff to ensure successful implementation.
11. Work to develop/communicate clinical and financial outcome reports to key managed care customers to secure a strongly favorable appreciation of the company's performance and capabilities
12. Manage the development and execution of a strategic marketing plan to obtain preferred provider relationships with key managed care organizations. Assure targets are defined.
13. Collaborate with team to consistently meet or exceed budgeted revenue and census goals.
14. Gather and analyze data on insurance companies and managed care providers to use in the development of pricing strategies.
15. Work in conjunction Case Management to assure proper clinical management of members with focus on quality outcomes and length of stay.
16. Evaluate that company has all necessary contracts required to increase referrals and admissions. This may include Genesis ancillary entities.
17. Gather industry intelligence, to include competitive offerings, market requests, trends and patterns of utilization, and seek out possible new business opportunities. Analyze data on insurance companies and managed care providers to use in the development of pricing strategies.
18. Support network with market changes surrounding Accountable Care Organizations, Bundled Payment, Medicaid Long Term Services and Supports (MLTSS), other Center for Medicare and Medicaid Innovation (CMMI) programs, etc.
19. Assist Revenue Cycle Management with respect to collection efforts with managed care payors.
20. Supervise, monitor and evaluate performance of assigned personnel.
21. Performs other duties as requested.
SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS:1. Undergraduate degree or above. 2. Seven to ten years of experience in health care or corporate account management with a proven successful track record.3. Three to five years of management experience. 4. Extensive business knowledge of payors, plans and all non-government revenue sources
Position Type: Full Time
Req ID: 387562
Center Name: Genesis HealthCare
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