Director, Managed Care

Description

Position Summary:

The Director, Managed Care is accountable for strategic partnerships with payers, including new business and revenue development through continued clinical integration and market expansion. The Director will own market strategy and partner with business operations, audit/compliance, and analytical support. Advises senior management of business opportunities and strategies for their market. 

Essential Functions and Job Responsibilities:

• Develops contracting plan and owns execution of rate increases for assigned geography.
• Leads and advances Strategic Partnerships for region, including clinical integration, enhancements in reimbursement, and innovative development, which includes negotiating alternative payment mechanisms, risk-sharing, and/or other reimbursement tactics to increase revenue.
• Provides guidance and direction to cross-functional business team members including Operations, Sales, Billing and/or Finance.
• Works closely with other team members to execute strategi initiatives including but not limited to:
• Defensible pricing strategies
• Innovative contracting solutions
• Contract operations improvements
• Partners with Contract Operations to ensure timely and accurate setup and ongoing maintenance of contracts with contracted entities including, but not limited to payors, facilities, subcontractors, and other legal entities. 
• Solves complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.
• Serves as a subject matter expert on contract and reimbursement-related issues impacting the home medical equipment and supplies business and healthcare industries, particularly with a managed care and commercial reimbursement focus.
• Manages a region and identifies and delivers on business opportunities and projects.
• Works with Audit and Compliance to ensure company stays in good standing with associated entities, regulations, and patients.
• Effectively evaluates and oversees TPA, as company moves forward with possible integration options. 
• Develops and maintains working knowledge of current HME products and services offered by the company.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program and applicable company policies, procedures, and patient protocols.
• Performs other related duties as assigned.

Management/Supervision:

• Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding, and providing comprehensive training and regular feedback.
• Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
•  Establishes annual goals and objectives for the department based on the organization’s strategic goals.
• Responsible for achieving organizational performance and retention goals, including timely completion of performance evaluations.

Requirements

Competency, Skills, and Abilities:

• Advanced Business Knowledge: Ability to see the field of the evolving and ever-changing healthcare landscape and understand the pressures, pain points and unmet needs that can translate into new business opportunities. Keen interest and passion for the latest technology and trends in transforming healthcare and shifting care to a value-based system.
• Executive Leadership and Presence: Bright, articulate individual able to move fluidly between managing day-to-day operations and the Board Room/Executive Suite; has the presence and credibility to instill confidence and trust both internally and externally.
• Attitude and Behavior Consistent with AHCO’s Culture and Values: A commitment to be able to live and promote AHCO’s values positively and proactively to patients, teammates, and business partners.
• Creativity: Business savvy, solution-oriented “architect”; deeply curious, high-energy, accountable and forward-looking.
• Disciplined/“Get It Done” Attitude: Must be a “working manager” and practical thinker, able to identify and devise realizable solutions and roll-up his/her sleeves to get things done; he/she must also be able to identify and alleviate any potential hurdles to achieving objectives, successfully managing people and projects, both directly and through influence.
• Ability to Influence: Effectively challenge and influence others to own the vision and strategies; Able to synthesize and embrace the mission of AHCO.

Education and Experience Requirements:

• Bac