College Division: USF Health-Morsani College of Medicine
Salary Plan: Administrative
Job Code/Title: 7890 / Director Managed Care-Health
Hiring Salary/Salary Range: Commensurate with Experience
Position Number: 00057571
ORGANIZATIONAL SUMMARY:
USF Health's mission is to envision and implement the future of health. It is the partnership of the University of South Florida Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences, and the USF Physician’s Group. USF is a global research university ranked 34th in federal research expenditures for public universities. For information regarding the USF Health, please visit our website at http://health.usf.edu/index.html
POSITION SUMMARY:
This position directs the development, negotiation, implementation, monitoring, management, and renegotiation of USF Health's contractual relationships with managed care organizations and other third-party payers. The Director of Managed Care is accountable for the management and direction of all functional areas within managed care for USF Health. This includes responsibility for the contracting and payer strategies for USF Health and other clinical providers within USF Health. Close collaboration with the Clinically Integrated Network (CIN) is essential. This position is USF Health’s chief managed care officer and negotiator for third-party payer contracts, payment policy innovation and development of future pay-for-performance strategies. The Director of Managed Care is responsible for advancing the organization's relationship with payers regarding payment. The following represent areas in which the Director of Managed Care is expected to make significant progress within the first 18 to 24 months of his/her tenure: Establish personal and professional credibility, gaining respect and building trust throughout USF Health, including those in senior leadership positions within USF Health’s clinical partners. Build strong working relationships with the faculty throughout USF Health, including Department Chairs and Business Administrators fostering an environment of collaboration, transparency, and trust.
Establish oneself as a highly accessible, visible, responsive, and knowledgeable executive, engaging faculty leadership in operational planning and decision making. Provide leadership and direction for USF Health to establish a comprehensive, long-term strategy that will position the organization not just for the next contracting cycles but also for future growth. Determine the strategy and goals of where the organization should be within the next three years. Develop goals and objectives to take the organization to the next level in managed care.
RESPONSIBILITIES:
Oversees and participates in the development, negotiation, implementation, monitoring and management of all the USF Health's managed care agreements which comprises over 68% of USF Health’s total business. Directs the scheduling, agenda, and business activities of the USF Health Managed Care Committee which is charged with the oversight and strategic direction of all of USF Health’s managed care business. Ensures that both pediatric and adult (MCOM) USF Health clinical practices receive optimal reimbursement and other terms for professional services delivered under managed care contracts. Ensures that all physicians and other health care providers are appropriately represented in payer’s system in line with contractual agreements for accurate roster representation and claims payment accuracy. Negotiates or oversees negotiations of original and renewal of managed care contracts that account for over $300M annually. Maximizes USF Health revenue by negotiating favorable terms for discounted fee-for-service, RVU-based, carve-outs, capitation, pay-for-performance (P4P) and other managed care contract payment methodologies. Collaborates as appropriate with hospital partners in aligning strategic interests.
Monitors performance of contracts through analysis of financial reports. Creates appropriate assumptions on payer mix, rate levels, shift amongst products, etc. for future budget modeling. Analyzes current book of contract business and presents pertinent information regarding the performance of contracts. Responsible for exploration of new payment models, risk sharing and evaluation of reimbursement levels with CIN partners for proposed contract opportunities. Identifies key financial factors for contract analysis and create template for modeling.
Collaborates with Revenue Cycle Operations, Finance, and Decision Support teams for execution of model output, modifications and resulting conclusions. Works with Revenue Cycle Director, Assistant Directors, and Managers to ensure appropriate payments according to contracts. Develops managed care policies. Troubleshoots with managed care companies when payment or contract compliance problems arise.
Directs and manages the overall activities of the Office of Professional Credentialing and Provider Enrollment, including direct supervision of the staff to ensure that timely and accurate enrollment and credentialing information is provided to the USF Credentials Committee, managed care plans, Medicare, and Medicaid. Directs the National Committee for Quality Assurance (NCQA) Certification process on a biennial basis. Management and direction of the Managed Care Department including personnel management (recruiting, hiring, training and counseling), setting of departmental policies, goals and objectives, and preparation, administration, and control of departmental budgets.
Liaison and collaboration with all clinical departments of the USF Morsani College of Medicine, other clinical entities within USF Health, and all administrative departments within the faculty practice plan on managed care issues. Educates and offers recommendations to the executive leadership of USF Health and clinical practice Business Administrators regarding MCOM contracting strategy. Provides general and specific managed care education to administration, practice boards, department chairs/administrators, committees, billing office staff and others to ensure appropriate understanding and expectations regarding managed care contracts.
Development of new USF Health business activities of selected clinical programs, niche services, and new product lines/programs with managed care plans and other relevant third-party payors. Expands USF Health clinical market share through on-going discussions and contact with managed care/insurance plans and the business community. Coordinates USF Health concerns in creating a single signature contract vehicle for pediatric care for unique contract opportunities. Collaborates with applicable USF Health staff and payers to explore, create, define, measure and execute a contract for P4P measures.
Performs other duties as assigned.
POSITION QUALIFICATIONS:
MINIMUM:
Bachelor's degree from a regionally accredited institution with a minimum of seven years related exempt experience, including five years of managerial experience. Experience leading a team, project, program, or function.
FLSB1310 equivalency:
Four years of directly related experience can be substituted for a Bachelor's degree.
PREFERRED:
Bachelor's degree in Business or Healthcare, MBA or MHA. Ten plus years of progressively responsible experience with health care insurance contractions on payer or provider side, contract negotiation and management experience, and knowledge of local and regional health care and pay market.
Significant knowledge of contractual, administrative, and operational issues related to managed care organizations, physician groups, and hospitals. Experience in managed care contracting within a faculty practice plan. Working knowledge of the NCQA Credentialing Standards.
Information for Applicants
This position is subject to a Level 1 criminal background check.
Job Opening Number: 37299
Posting Date: 06/28/2024
Posting End Date: 07/12/2024
How To Apply
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Apply online by completing the required information and attaching your cover letter and resume. Please include your experience as it relates to the qualifications stated above. YOUR COVER LETTER AND RESUME, PLUS ANY OTHER REQUESTED MATERIAL, MUST BE IN ONE ATTACHMENT. Only online applications are accepted for this position.
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To request an accommodation with the application or interview process, please contact Central Human Resources by telephone: 813-974-2970 or email HR-ADA-Request@usf.edu.
Equal Employment Opportunity
USF is an equal opportunity, equal access academic institution that embraces diversity in the workplace.The University of South Florida does not discriminate on the basis of sex and prohibits sexual harassment. Any person may report sex discrimination, including sexual harassment (whether or not the person reporting is the person alleged to be the victim of conduct that could constitute sex discrimination or sexual harassment), in person, by mail, by telephone, or by electronic mail, using the contact information listed for the Title IX Coordinator. Reports may be made at any time either online or directly to the University's Title IX Coordinator.
Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA), Equal Employment Opportunity (EEO) and Employee Polygraph Protection Act (EPPA).
Work Location
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USF - Health
USF - Tampa Campus
About USF
The University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report's national university rankings than USF. Serving more than 50,000 students on campuses in Tampa, St. Petersburg and Sarasota-Manatee, USF is designated as a Preeminent State Research University by the Florida Board of Governors, placing it in the most elite category among the state's 12 public universities. USF is a member of the American Athletic Conference.
Working at USF
With more than 16,000 employees at USF, the University of South Florida is one of the largest employers in the Tampa Bay region. At USF you will find opportunities to excel in a rich academic environment that fosters the development and advancement of our employees. We believe in creating a talented, engaged and driven workforce through on-going development and career opportunities. We also offer a first class benefit package that includes medical, dental and life insurance plans, retirement plan options, tuition program and generous leave programs and more.
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