Director, Managed Care
Company: Phoenix Children's Hospital
Posted on: September 12, 2021
Posting Note: **THIS IS AN ONSITE POSITION LOCATED
IN PHOENIX, AZ. Relocation Assistance will be offered.
The Director, Managed Care is responsible for the managed care
contract life cycle, including, negotiation, implementation,
coordination of third party payer agreements and managed care
contracting for the Phoenix Children`s enterprise. These agreements
may represent contractual relationships with the public sector,
commercial health plans, or employer-sponsored health plans in a
fee-for-service, value-based, or risk arrangement. The Director,
Managed Care will have oversight of Provider Enrollment, ensuring
timely and accurate enrollment of facility and employed providers
with third party payers. The Director, Managed Care will have
responsibility for Payer Relations, maintaining positive working
relationships necessary to effectively and efficiently obtain and
operationalize contracts. This position reports to the Vice
President, Managed Care and supports PCH, PCMG and PCCN contractual
- Family-Centered care that focuses on the need of the child
first and values the family as an important member of the care
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share
our mission and goals
- Leadership that set the standard for pediatric health care
today and innovations of the future
- Accountability to our patients, community and each other for
providing the best in the most cost-effective way.
- Directs all contracting activities for the enterprise-wide
payor contract portfolio.
- Directs contracting staff activities to achieve optimal
contract financial and operational outcomes as well as effective
contract management. Responsible for contract negotiations,
including rates, payment methodologies, contract language and value
based payment programs in accordance with internal control
processes for contract review, approval and signature. Ensures
contracts are negotiated within established parameters and
acceptable time frames for maximum performance. Makes
recommendations for contract strategies.
- Oversees the activities of the Provider Enrollment staff.
- Oversees the activities of the Provider Enrollment team to
ensure timely and accurate enrollment of facilities and employed
providers with contracted payers. Ensure compliance with
credentialing, recredentialing and delegated credentialing
requirements related to Provider Enrollment. Monitor and update
provider demographic information.
- Educates network providers and staff on key managed care
principles, market trends, and opportunities for improvement in
support of enterprise goals and objectives
- Prepares and provides training on pertinent subject matter to
network providers. Proactively communicates and educates
operational areas on contract changes, policy updates, etc. To
ensure staff have information needed to successfully implement and
operationalize agreements. Participates in or conducts
presentations as needed.
- Coordinates and leads activities using a collaborative and team
- Demonstrates attention to detail, strong interpersonal skills,
and project management skills to effectively conduct team meetings,
engage team members, secure cooperation, and accomplish department
goals and objectives. Handles multiple projects and ensures teams
perform as needed under tight deadlines with a focus on effective
implementation, communication and follow-up. Maintains
collaborative, team relationships with peers and colleagues in
order to effectively contribute to the working group`s achievement
of goals and to help foster a positive work environment.
- Plays a key role in managing relationships for network
hospitals, physicians, ancillary providers and vendors related to
managed care agreements.
- Ensures contracting, payor relations and provider services
staff develop positive, effective relationships with internal and
external customers. Provides direction needed by staff to interface
effectively with internal staff, providers, payors, and health
plans in negotiations, problem resolution and dispute
- Performs miscellaneous job related duties as requested.
Keywords: Phoenix Children's Hospital, Peoria , Director, Managed Care, Other , Peoria, Arizona
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