Regional Director of Managed Care & Payor Relations | PAM Health Corporate & Voyages BH

Overview

The objective of the Regional Director of Managed Care is to ensure that PAM Health and our key facilities participate in key managed care plan networks within their respective markets and maintaining/developing relationships with targeted Payor sources.  The position is responsible for securing, maintaining and renegotiating payor contracts that meet and or exceed the business and financial objectives of PAM Health.  

The Director of Payor Relations develops the payor  network (Managed Medicare, Managed Medicaid, Exchange Health Plans, ACOs, Bundled Payments and other Gain Sharing Programs, etc.) yielding a geographically competitive, broad access, stable referral and payment source that achieves objectives for unit cost performance and trend management.  This position evaluates and negotiates contracts in compliance with PAM Health requirements, reimbursement structure standards, and other key process controls. Responsibilities also include serving our PAM Health facilities and Corporate and Regional Operations for contract specific information to the Facilities, business office, admissions, operations and the central billing office (CBO).   The position will be responsible for developing, managing and maintaining the Payor summaries on an ongoing basis and insuring the sharing of key Contract Rate Schedules with any partner organizations that have a need to know the information as Business Associates.

Responsibilities

• Serve as a strategic, educational, and support to the District/Regional teams and corresponding care centers for Managed Care/Payor contracts and initiatives.
• This role involves the Voyages Behavioral Health Psychiatric Hospitals in terms of all Managed Care contracting responsibilities including I/P and O/P and Spravato Depression Outpatient program. Also responsible for “Smart Sheet Contract Summaries on Voyages Health Plan agreements.
• Responsible for establishing and managing relationships with local/regional/national managed care leadership and ensuring that colleagues in Central Billing Office, Facility Admissions, case management, have immediate access to their corresponding contacts for rates and terms.
• In collaboration with the EVP of Admissions and the Vice President of Managed Care,, identify and support the development and implementation of local opportunities for the districts through contracting, education and strategic initiatives including Public Payors for Psych Services.
• Support Episode of Care Management and serves as a resource expert to facilities, regional teams, and Corp Finance etc.
• Resolve escalated issues with payors related to payment and/or other systemic issues that are contractually based in concert with our Central Billing Office.
• Collaborate with the CBO Leadership on escalated claim issues and requested contracts.
• Report opportunities and threats related to Managed Care/Payors to SVP of Managed Care. When possible, provide analytics on the potential or risk to Consulate as well as recommendations.  Also provide Transparency Completive Information to SVP of Managed Care and Corporate Office. 
• Identify payors in specific districts for which contracts are needed and, in collaboration with SVP of Managed Care, take steps to secure agreements and relations that maintain and/or increase utilization for Consulate.
• Coordinate closely with Regional Operations Teams to coordinate efforts to achieve the goals of admitting more Managed Care Patients at Preferred Compensations terms.
• Assist and support the Central Billing Office team with escalated insurance payor issues and trends to help drive down days of sales of outstanding (DSO) to a reasonable level from each health plan.
• Participate in the development and management of a disciplined contracting process. Provide recommendations and feedback to ensure the process stays current and meets the business and financial objectives of Consulate. 
• Stay current on payor, reimbursement, CMS and other health care reform issues.
• Oversee, manage and negotiate all managed care agreements as assigned by supervisor. Take on new facilities for IRF and LTACH as assigned by SVP.
• Provide leadership within the contracting team, and manage the priorities, standards, and work.
• Develop a disciplined contracting process that meets or exceeds PAM Health’s business and financial objectives.
• Develop relationships with key payors’ decision makers for both contracting and referral management. Understand the payor strategy and opportunities and threats to PAM Health.  Communicate the opportunities and threats to your leadership.  Participate in strategies and plans to best position PAM Health with Payors.
• Use pertinent data and facts to identify and solve a range of problems related to managed care and payor contracts/