Managed Care Program Director - Contracting (Orange County/Irvine, CA)

About City of Hope

City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.

Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation's leading cancer centers that develops and institutes standards of care for cancer treatment.

Position Summary:

Responsible for leading payor negotiations on behalf of COHMF and COHNMC, implementing the payor strategy, increasing patient volume by identifying and pursuing new sources of business for the Medical Center and Medical Foundation Community Practices in Orange County and surrounding areas. Evaluates and negotiates new and existing contractual arrangements, facilitating development of internal systems that are customer oriented and market sensitive, supporting business development community expansion for the Orange County region, and building and maintaining ongoing relationships with payers and other customers. Reports directly to the Vice President, Payor Strategy with a dotted line to the Senior Director, Business Development in Orange County.

Key Responsibilities include:

Managed Care Responsibilities:

• Leads negotiations with medical groups/IPAs in the community on behalf of COH's sites in Orange County and surrounding areas.
• Leads evaluation and implementation of payor strategy in Orange County and surrounding areas
• Leads managed care negotiations with health plans in the Orange County region
• Identifies and pursues new payers and other sources of potential business in Orange County and surrounding areas. Negotiates all aspects of managed care contracts.
• Negotiates patient specific letters of agreement for services in the Orange County region
• Responds to RFPs from payors in the region to become a preferred oncology provider
• Serves as managed care expert for Orange County and surrounding areas
• Works with Integration Team on managed care related matters impacting practice acquisitions and physician integration.
• Collaborates with Orange County leadership to support market growth and relationship development with payors, employers and providers in the region.
• Participates in system-wide payor contract negotiations
• Implements new payer contracts including organizing interface meetings, developing policies and procedures and internal communications.
• Develops and enhances existing payer relationships through responsive problem solving and servicing. Constantly seeks ways to improve service and overall value generated by City of Hope. Routinely analyzes contract financial and volume activity and recommends corrective action plans when necessary.
• Works closely with Foundation practice directors, physician liaisons, business development and community medical groups to increase access to City of Hope
• Provides feedback to internal staff regarding customer perceptions and needs. Facilitates internal meetings and participates on work teams to refine systems and services to support managed care and enhance payer servicing.
• Educates internal personnel on the reimbursement and operational terms of managed care contracts.
• Works with internal constituencies to ensure that the managed care contracts meet the needs of the COHMF and COHNMC from legal, financial, and operational perspectives.
• Provides revenue cycle support for the Orange County region; helps resolve habitual or high dollars claims issues for COHNMC and COHMF.

Personnel Management Responsibilities:

• Work with HR on the interviewing, selecting, and hiring of employees for the department as needed.
• Provide oversight and direction to assigned employees in accordance with the organization's policies and procedures.
• Consciously create a workplace culture that is consistent with the overall organization's and that emphasizes the identified mission, vision, guiding principles, and values of the organization.
• Lead employees to meet the department's expectations for productivity, quality, and goal accomplishment.

Additional Duties:

• Maintains professional growth and development and keeps abreast of latest trends in area of expertise.
• Attends meetings as required and participates on committees as directed.
• Co-chairs Managed Care/Business Development meetings for Orange County and surrounding areas
• Co-chairs monthly Managed Care Operations Meeting
• Participates in monthly Managed Care/Foundation Revenue Cycle meetings
• Maintains a positive image when dealing with department personnel, City of Hope employees, and external constituents.

Basic education, experience and skills required for consideration:

Minimum Education:

• Bachelor's Degree in Business Administration, Health Care Administration or related field is required. Master's degree is preferred.

Minimum Experience:

• 7+ years managed care contracting experience in hospital, medical group, health plan, or Independent Practice Association (IPA).
• 5 years of experience in a leadership capacity
• Experience contracting for oncology services preferred

Additional Information:

To protect the health of patients and staff and to comply with new State of California mandates, City of Hope staff are required to show proof of full vaccination by September 30, 2021. Compliance is a condition of employment.

City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

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• Posting Date: Dec 1, 2021
• Job Field: Business Services
• Employee Status: Regular
• Shift: Day Job