Role Overview

Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payers and providers
Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
Responsible for coordination and communication between managed care and other interested party departments and leadership
Responsible for developing new and existing relationships with medical and pharmacy plans to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
Oversight of payer credentialing
Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
Communicates with respective payers related to trends and compliance with contract parameters
Consistently represents the company in a professional manner
Maintain effective working relationships and cooperate with all personnel in the Company
Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies

Requirements

Bachelor’s Degree preferred or equivalent experience
At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience
Preferred experience in managing, analyzing, and reporting denials and appeals.

CSI Pharmacy

Open Positions (1)

Management

Managed Care Regional Director