Senior Director, Managed Care and Clinically Integrated Network

Job Summary : The Senior Director, Clinically Integrated Network (CIN) provides strategic leadership, financial and administrative oversight of all clinically integrated network activities on behalf of CaroMont Health System.

Includes insurance products, managed care contracts, wellness products and care management products. This position directs all strategies that optimize current and future financial performance for governmental, commercial and employer-direct customers.

The Senior Director initiates and maintains relationships with managed care organizations, providers, governmental payors and employers.

Develops and directs all clinically integrated network activities of the organization, including product development, contract negotiations and review of contract compliance and profitability.

Successfully recruits community providers to join our CIN. Collaborates with clinical leadership to identify how payors value our improvements in clinical quality and outcomes.

Develops relationships with major employers and brokers to determine which products are selling in the marketplace and which products are wanted or needed in the marketplace;

develops plans to meet their needs and wants. In collaboration with CFO, Senior Leaders, Physicians, Service Line and Quality Leadership, and other leaders, the Senior Director develops a portfolio of network products and participating network contracts designed to enhance revenue and patient access.

Monitors and ensures compliance with key performance indicators upon which the portfolio is evaluated, supporting the vision of CaroMont Health to be our community’s most trusted healthcare partner.

Develops appropriate training, resources and programs regarding planning and analysis for Clinically Integrated Network team members and ensures these resources and programs are effectively used

Qualifications : MHA, MBA and / or CPA required. Position requires minimum ten years progressive, innovative managed care leadership experience within a major payor and / or health system.

Managed care contracting experience in health care or managed care industry; significant knowledge of contractual, administrative, health insurance and operational issues related to managed care, physician groups, hospitals, employer health benefits and health insurance benefit plan designs required.

Candidate will have a record of demonstrated financial and business acumen within large / complex organization(s). Advanced analytical, strategic planning and forecasting skills.

Proven success in negotiations within major managed care or provider organization(s) and employer-direct contracts, as well as expertise with a variety of fee-for-service and value-based arrangements.

Must demonstrate strong communication and presentation skills, an innovative style that creates new ways to develop business and enhance revenue, has the ability to create and maintain positive relationships with all CaroMont Health departments and affiliates, community leaders and constituents.

A team player who takes ownership, who is insightful, reads interpersonal relationships well. Demonstrates an assertive and straightforward can-do style, and models a leadership style that emphasizes empowerment, coaching, mentoring, accountability, accessibility, trust, empathy and team development.

Actively and clearly exhibits C.A.R.E.S. values.

EOE AA M / F / Vet / Disability

PI254185140