Under minimal supervision, recommends, develops, coordinates and implements activities in support of strategic direction for managed care plans at the state level for 10 or more managed care markets and at least $1.1 billion in managed care annual gross revenue. Will support multiple Executive Directors in the state. Represents company in market assessments, managed care contract negotiations, and related activities. Works with state contracts administration to ensure effective implementation and management of contracts. Ensures services are negotiated, marketed, and sold in accordance with budgeted objectives in order to obtain maximum profitability and volume. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
-Analyzes markets from a strategic perspective, develops managed care strategies and tactics by market and at the state level.
-Develops and implements managed care goals and objectives at the state level and ensures their execution.
-Recommends and gains support of physicians and operations to ensure optimal implementation of the managed care strategy.
-Maintains awareness of market, payor, and competitive managed care activities and adjusts strategies accordingly.
-Works with state contract administrators to ensure effective implementation of new and renegotiated contracts and to resolve problem payor issues.
-Communicates effectively with management, physicians, and business office/contract administration on the status of contracting and problem payor issues.
-Reviews and negotiates contract language and pricing terms in accordance with budgetary objectives and policy and procedure to maximize benefit to the company.
-Represents the physician practice and company to payors and regulatory authorities in matters related to managed care services at the state level.
-Effectively communicates trends and issues to corporate managed care through ad hoc communications, monthly and quarterly reports.
-Works with corporate managed care to recommend changes in contracting and reimbursement guidelines to ensure achievement of reimbursement maximization as it relates to managed care.
-Provides work direction and leadership to state Managed Care staff.
Bachelor’s degree in Finance, Accounting, Business, or Healthcare Administration. MBA or MHA preferred. Minimum ten years healthcare management experience in a managed care environment. Knowledge of healthcare planning, finance, marketing, reimbursement, and related activities.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires sitting for long periods of time. Some bending and stretching required. Adequate finger dexterity and feeling to perform keyboarding and substantial repetitive motions involving the wrists, hands and/or fingers. Requires corrected vision and hearing to normal range. Must be able to view computer screen and printed material accurately. Occasionally lifts and carries items weighing up to 40 lbs.
The 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. The work environment is typical of an office setting. Requires occasional travel by air or automobile.
About Maryland Oncology Hematology
Maryland Oncology Hematology (MOH) is the largest independent oncology practice in the state of Maryland , with more than 45 clinicians practicing in 13 locations across Maryland devoted exclusively to providing comprehensive, compassionate, and high-quality cancer care. MOH specializes in medical, gynecologic, hematology, radiation oncology, surgical oncology, cancer genetic risk assessment, clinical trials and research, and patient ancillary programs. MOH believes it is beneficial to provide cancer therapies in a community setting, close to patients’ homes and support systems. The physicians are supported by a talented clinical team sensitive to the needs of cancer patients and their caregivers. For more information, visit MarylandOncology.com.
Maryland Oncology Hematology is a practice in The US Oncology Network (The Network). This collaboration unites the practice with more than 1,200 independent physicians dedicated to delivering value-based, integrated care to patients — close to home. Through the Network, these independent doctors come together to form a community of shared expertise and resources dedicated to advancing local cancer care and to delivering better patient outcomes. The Network is supported by McKesson Corporation, whose coordinated resources and infrastructure allow doctors in The Network to focus on the health of their patients, while McKesson focuses on the health of their practices. Maryland Oncology Hematology also participates in clinical trials through US Oncology Research, which has played a role in more than 100 FDA-approved cancer therapies.