Dir Payor Relations & Contract Performance

PURPOSE AND SCOPE:

Oversees and directs the functions and activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMO, PPO, POS, etc.) for Payor Relations.

Oversees contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per FMCNA guidelines, and contract maintenance such as facility list updates and amendments. 

PRINCIPAL DUTIES AND RESPONSIBILITIES:


* Provide strategic leadership of short- and long-term goals through the use of thoughtful techniques in the communication of the company's mission and core values as a means to implement positive change and/or create organizational structure within the assigned business unit(s).


* Lead operational efforts through subordinates to complete the administration of business processes and services to ensure the operations effective achievement of goals within the assigned business unit(s).


* Direct and control the broad activities of the business unit(s) through the interpretation, application and implementation of company-wide policies and processes appropriate to the functional area(s).


* Provide leadership, guidance and coaching for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.


* Collaborate with employees in the establishment of clear and concise development plans to ensure succession planning and the advancement of future leaders within the organization.


* Technically proficient leader in the specific department and knowledge of industry practice and business principles.  Has a large range within a department or multiple departments.


* A strong tactical decision-maker; role primarily focuses on tactical execution.  Handles unforeseen issues.


* Works on complex issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.  Has significant program or project responsibility generally within the function.


* Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results.


* Decisions have an extended impact on work processes and outcomes.  Erroneous decisions will result in critical delay(s) in schedules and/or unit operations, and may jeopardize overall business activities.


* Requires the ability to change the thinking of, or gain acceptance from, others in sensitive situations, without damage to the relationship.  Regularly interacts with senior management or executive levels on matters concerning several functional areas, divisions, and/or customers.


* Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution.  Responsible for hiring, coaching and counseling employees, including performance reviews,...