Sr. Director of Managed Care Contracting

How You’ll Help Transform Healthcare:

*The position is onsite in Roanoke, VA. Relocation assistance will be provided.*

The Senior Director of Managed Care Contracting serves as a leader in organization management of payer contracting including portfolio, performance, execution, coordination and implementation of Value Based and Fee-For-Service arrangements for facility, physician, and ancillary agreements. You will assist with price modeling, hospital contract modeling, performance monitoring and auditing. Additionally you will facilitate the implementation of new processes & programs on a cross-department organizational structure. 

Duties may include but not limited: 

• Works in close cooperation with Vice President to ensure current contracts are managed well while assisting in developing innovative future contracts and relationships with payers and employers.

• Responsible for analysis and contracting of risk and non-risk contractual arrangements (including reimbursement and contractual language) between Carilion Clinic, owned and affiliated hospitals, ancillaries, Physicians (medical groups) and third-party payers for the provision of health care services to member/patients.  Payers include Commercial Insurance, Medicare Managed Care, Medicaid Managed Care, Third Party Administrators, Workers’ Compensation and Employers under Direct Contracts.

• Executes and monitors a payer performance and accountability structure which will administer, track and resolve contractual performance and business activity supporting the ability to maximize organization revenue, growth and retention.

• Achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance including the management of hospital write-offs due to no authorization, medical necessity denials, or other reasons for writing-off any portion of an account.

• Oversee the Contract Management area to ensure Carilion is obtaining maximum reimbursement allowed by payer.

• Works to negotiate and implement delegated credentialling contracts in order to improve timeliness of provider enrollment with payer. 

• Will be Carilion's representative on the VHHA Payer Advisory Council to assist in addressing payer concerns at a state level. 

• Supports development, implementation, and compliance of Managed Care policies and procedures necessary to support operations. 

• Supervises staff in contract management, contract compliance, modeling and financial analysis. Designs, establishes, and maintains an organizational structure and staffing to effectively accomplish the organization's goals and objectives: recruits, employs, trains and evaluates staff. 

What We Require:

Education: Bachelor’s Degree in accounting, finance or business administration. Master’s degree in business administration or related field desirable.

Experience: Seven years experience in healthcare finance, accounting or financial planning

Licensure/Certifications/Registration: CPA desirable

About Carilion

This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.