Sr Director Managed Care and Payor Strategy

Sr Director Managed Care and Payor Strategy

PURPOSE AND SCOPE:

The Senior Director of Managed Care & Payor Strategy is a strategic leader responsible for driving initiatives that strengthen relationships with Managed Care Payor Organizations and optimize contractual performance. This role leads a high-performing team, fostering collaboration and innovation to achieve organizational goals in managed care contracting, quality outcomes, and marketing strategies.

• Manages contracting and relations with managed care organizations.
• Develops long-term strategies and tactics for managed care contract review and analysis.
• Leads the initiation, negotiation, and execution of contracts.
• Oversees the maintenance of relationships and issues resolution with managed care organizations.
• Ensures all contracts are compliant with internal and governmental regulations.
• Supports and improves employee engagement & team culture
• Supports FMCNA's mission, vision, values and philosophy.
• Adheres to the FMC Compliance Program, including following all regulatory and FMS policy requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Formulates market strategies and develop an implementation plan for a contract portfolio that involves multiple sites, geographies and products.
• Leads the end-to-end negotiation of national and regional payor agreements, including initial rate development, contract language negotiation, and oversight through final implementation of executed agreements.
• Represent Fresenius Kidney Care services to payors and other stakeholders through compelling presentations and communications.
• Develops direction, goals and priorities of team members.
• Oversee the evaluation, analysis and preparation and completion of Managed Care contract proposals for direct reports.
• Outlines revenue targets as team initiatives and manages collective and individual performance towards achievement of goals.
• Provides clear, accurate guidance to leadership team and operational partners regarding contracting targets, goals and objectives.
• Collaborates effectively with Operations, Clinical and Support teams to implement strategy and achieve goals.
• Works closely with Operations and leadership to maximize growth opportunities and strengthen payor partnerships.
• Assists senior management in the preparation of financial budgets and quarterly forecasts.

QUALITY:

• Responsible for leading team responsible for negotiating and implementing contracts with payers that require clinical and quality outcomes measurements.
• Responsible for the design and implementation of third party payor compensation structures including quality outcome measures, pay for performance, risk and various other structures and metrics.
• Responsible for ensuring that quality and financial outcomes are reported accurately and in a timely manner.
• Assist with designing Quality Improvement Projects that will improve outcomes in practices that are not meeting goals.
• Obtain payor fee schedules and ensure contract compliance.

FINANCIAL/OPERATIONAL MANAGEMENT/BUSINESS PRACTICES:

• Oversee contract performance for managed care contracts, ensuring achievement of budget and key performance indicators.
• Responsible for implementation and achievement of business plan, budget, and key performance indicators.
• Reviews contracting performance with Leadership and Operations on a quarterly basis at a minimum.
• Trains and supports Managed Care Directors regarding business goals and practices.
• Works with internal and external counsel as per Company policy and as needed to resolve issues and support FMCNA as appropriate.
• Ensures all FMCNA business policies, procedures and systems are implemented by the appropriate personnel, including compliance with ethical business practices.

MARKETING:

• Responsible for achievement of business plan, budget and key performance indicators.
• Responsible for collaborating with Operations team to maximize growth opportunities through third party contractual relationships and stratigic partnerships.
• Responsible for communicating Fresenius Kidney Care’s services through presentations to third party payers, managed care organizations, internal departments and other appropriate audiences.
• Maintains knowledge of Fresenius Kidney Care products, services and strategies.
• Maintains current knowledge regarding community healthcare market and industry issues that may impact the business.
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or