Director, Managed Care - Navista

Position Summary

At Navista, our mission is to empower community oncology practices to deliver patient-centered cancer care. Navista, a Cardinal Health company, is an oncology practice alliance co-created with oncologists and practice leaders that offers advanced support services and technology to help practices remain independent and thrive.​ True to our name, our experienced team is passionate about helping oncology practices navigate the future.

The Director, Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible to implement strategic initiatives related to payer contracts. The Director, Managed Care contributes to practice growth and profitability by providing contracting expertise to existing and new contractual relationships; and providing subject matter expertise, guidance, and direction regarding managed care contracts. This includes coordination of commercial, Medicare Advantage, Managed Medicaid and other third-party managed care contracts and payer relation activities.

This role’s primary focus is to work diligently to ensure optimal reimbursement for physician services and physician satisfaction as it relates to managed care contracts and operations. This position is responsible for administrative, strategic, business development, and contracting activities related to the Managed Care environment. They will be a seasoned leader and advisor, with proven experience supporting physicians in oncology to identify and realize payer specific reimbursement opportunities.  Has primary responsibility for successful implementation of the managed care strategy and achievement of the business case, including oversight of managed care and reimbursement operations across Navista practices and business lines directly or in partnership with other leaders. Responsibilities also includes oversight and management of credentialing functions.

This position reports to the VP, Operations for Navista.

This is a remote, work from home role with travel up to 50%.

Responsibilities

• Develop and manage a team of managed care and credentialing specialists, vendors and consultants. Oversee practice managed care and credentialing staff.
• Periodically assess local and global market reimbursement rates for clinical procedures. Develop and communicate with physician and executive leadership teams, payer specific Managed Care analytics and reports on a regular basis
• Directly responsible for practice’s managed care strategy development and execution. Develop strategies and action plan to implement opportunities for rate improvements.
• Monitor relevant practice specific payer trends and compare to global and/or market trends. Advise physicians and operations leadership on reimbursement risks as it relates to specific procedures and codes. Act as an internal resource in interpreting managed care contracts.
• Direct the daily operations of managed care contracting and payer relations to include contracting activities such as focusing on rate strategies, maintaining strategic internal and external relationships, evaluating contracts and related contractual relationships
• Negotiate contract renewal terms and develop and implement new contracts based on contract goals and parameters. Create and implement new rate structures that enhance reimbursement when appropriate.
• Lead proactive contract renewal by working closely with operations, revenue cycle and finance leadership to develop contract proposals based defined strategies, goals, and objectives
• Provide managed care consulting and leadership relative to business direction, strategy and network positioning as they relate to payer reimbursements
• Disseminate relevant contract details to all relevant departments (such as patient access, registration, business office, finance, practice operations etc.) to facilitate contract administration and execution
• Support clinic and admin departments in understanding operational issues as they relate to specific contracts and patient populations (e.g., collections, prior authorizations, referrals, etc.)
• Direct the preparation and distribution of managed care reporting for senior Navista and physician leadership demonstrating financial analysis of current and proposed managed care contract performance and utilization.
• Provide input to finance department with respect to contract performance analysis and monitoring
• Works effectively with multiple practice departments, external payers, hospital and health systems, CIN’s, IPA’s, etc. and payors to develop and negotiate contract opportunities
• Support managed care strategy and contracting activities related to special projects, including new practice acquisitions and addition of new services
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