Apply on Employer Site

UF Health Jacksonville · 5 months ago

Director of Managed Care Contracting & Operations

Gainesville, Florida

Full-time

Onsite

Lead/Staff, Director/Executive

5+ years exp

UF Health Jacksonville is seeking a Director of Managed Care Contracting & Operations to provide leadership to the Managed Care Account Management and Population Care Management teams. This role involves overseeing various staff, managing contracting processes, and ensuring operational efficiency of contracts while building strategic relationships across operational areas.

EducationHealth CareHospital

No H1B

U.S. Citizen Only

Responsibilities

Responsible to interface with other operational areas and build strategic relationships between ones' area and other areas

Responsible for managed care contracting, including but not limited to value based and pay for performance contracting, and population health initiatives to position SUFHCN (hospitals, ancillary facilities, and UF and Shands physicians and providers) as a major referral institution for the state of Florida, and as the dominant health care provider within its local service area and surrounding core counties

Also responsible for ensuring the operational efficiency of existing contracts. The Director, Contracting & Operations, works with the Assoc. Vice President of Managed Care in determining payor contracting strategies, negotiating contracts, policy development, departmental goals, and planning

The Director also prioritizes and directs the workload of staff and initiating and coordinating contract negotiations activity across functional areas (legal, pricing analysis, billing and AR, UF clinics and hospital operations, physicians and other providers, network management and contract management) to ensure contract implementation, execution, and improved contract operational and financial performance

Qualification

Managed care contractingFinancial negotiationFinancial analysis methodsClaims managementProject management

Required

Requires a BS or BA degree in business or health care field and 5 to 7 years of experience in managed care industry - whether payor or provider-related, with direct supervisory experience

In lieu of a BS or BA degree, the candidate must have an AA degree and 7 to 9 years of experience, or a high school diploma with 9 to 10 years of experience

Must have experience with contract review and financial negotiation and knowledge of financial analysis methods (including payor and provider pricing, actuarial risk analysis, and premium development), claims management, utilization review management, benefit plan management, and financial and accounts receivable report management

Must have experience in managing projects and work product of other professional-level personnel