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 location specific functions.

Impact

• Leads a department or a small-sized organization within a region / global division, which may include a limited number of teams led by other middle management positions.

• Establishes and implements mid to long-term (3-5 years) strategies that have measurable impact on the achievement of business results within the context of the overall regional / divisional business strategy.

• Responsible for identifying, building and managing long-term key client relationships.

• Leads negotiations on issues that have a high impact on the function or on business results.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Day to day work includes desk and personal computer work and may include interaction with managed care organizations, patients, staff, facilities and physicians.
• The position may require travel throughout the country.

SUPERVISION:

• May be responsible for the direct supervision of Directors of Managed Care, Manager of Revenue support, Contract Managers, and other staff as assigned.

EDUCATION:

• Bachelor's Degree in Business or Health Management or related field (required);  Advanced Degree in Business or Management (preferred)

EXPERIENCE AND REQUIRED SKILLS:

• 10 years of extensive, direct experience in managed care contracting.

• 5+ years direct supervisory experience.

• Competency with standard business computer systems.

• Strong written and verbal communication skills.

• Payor relationship building.

• Strategic planning.

• Analytical decision-making.

• Ability to work independently.

• Goal Oriented.

• Experience with provider and/or payor contracting.

The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies.

Annual Rate: $200,000.00 - $270,000.00


Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance.

EOE, disability/veterans