DIR MANAGED CARE

Moffitt Cancer Center - Tampa, FL4.0

Full-timeEstimated: $81,000 - $110,000 a year
EducationSkills
Moffitt Cancer Center is internationally recognized for our focus on personalized cancer care and translational research. The mission of Moffitt is clear, focused, and fully stated in nine words, "To contribute to the prevention and cure of cancer." With a tradition of excellence that began with the first patient admission in 1986, dedicated Moffitt physicians, scientists, and staff members have remained committed to excellence in an atmosphere characterized by kindness, caring, and hope.

10 years experience

Position Highlights:
  • This position is responsible for planning and directing the activities of the Managed Care Department to support the Cancer Center's strategic vision for managed care. He/she will oversee all Cancer Center managed care contracts including hospital, employed physician group, delegated credentialing, and Center of Excellence agreements (BMT and Car-t). Under the leadership of the Vice President of Payer Strategies and in collaboration with the Director of Payer Strategies - Cancer Care Delivery, the Director of Managed Care is responsible for negotiating the Cancer Center's fee for service contracts and alternative payment model arrangements including bundled payments, shared savings, and risk contracts. The Director of Managed Care actively participates in Moffitt's strategic planning initiates to provide payer insights for the future growth of the Cancer Center. The Director of Managed Care actively supports the Payer Strategy responsibilities as part of strategic partnerships.
  • Also developing the negotiating posture related to contracts terms and conditions for each negotiation. This includes development and communication of the negotiating strategy as well as the execution by the managed care team. The Director is responsible for advancing pricing strategies and terms that support the strategic initiative of the organization. The Director will design proactive initiatives with third parties that optimize finances and opportunities for greater efficiencies. As well as addressing health plan policies and trends across the revenue cycle including patient access, financial clearance, and patient financial services departments. He/she ensures that the Cancer Center's managed care contracts are performing as intended. The Director of Managed Care facilitates regular meetings with health plan representatives to foster strong working relationships and provide a forum for Cancer Center departments to solve problems. Disputes related to health plan policies or changes that impact the Cancer Center are managed under the leadership of this individual..
The Ideal Candidate will have

  • A preferred certification as a CPN - Chartered Professional Negotiator and/or CPA – Certified Public Accountant.
  • Preferred six (6) years' experience in healthcare revenue cycle or payment integrity process. Demonstrated track record of success in a similar role with experience directing and managing all aspects of third party contracting within complex health system. Ideally demonstrated experience in strategy design, reimbursement analytics and managed care contract negotiations for both the hospital, physicians and other providers.
  • Preferred three (3) years' experience with Oncology and/or cancer related field especially as it related to reimbursement and payer emerging issues. . Demonstrated success in building a pricing strategy with advanced terms/conditions that meet the needs of a complex, tertiary care facility. Including strategies related to advancing price transparency, it's impact and implementation.
Responsibilities:
  • Supervise staff
  • Contracting
  • Operations
  • Special Projects/Other
Credentials and Qualifications:
  • Bachelor's Degree in business or related field specifying in negotiation expertise/field of study required.
  • Minimum of ten (10) years of managed care experience, healthcare finance, strategy, or healthcare management; including six years of progressively challenging experience in managed care in the health care provider or payer settings.
  • Minimum of six (6) years' experience with demonstrated success in executing successful third party negotiations with appropriate communications, analytics, and results.
Minimum of four (4) years demonstrated skills in areas supervision, management, written and verbal communication, judgment, problem solving, and presentations.