The posting
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet. The Director, Managed Care provides strategic and tactical support to leadership on the development of strategic partnerships with payers and affiliated provider organizations. The incumbent serves as a key tactician in maintaining and expanding UHealth’s competencies and investments in clinical specialties, robotics, satellite expansion, capital investments, and quality improvement initiatives, among others to ensure the organization is competitively positioned in partnership with key organizations for long term success. Focuses on volume growth, market share expansion, and strategic partnerships with payers, affiliated provider organizations, employers, and other healthcare stakeholders. Executes strategies and directs operations to protect and grow market position. Drafts and presents facts-and-projections-based presentations (i.e. storyboard) that help to attract potential partnerships with payers and affiliated provider organizations. Maintains current knowledge of community developments as it pertains to competitive issues in managed care Ensures major payers, regional hospitals, physician groups, and ancillary service providers consider UHealth the most valued partner in the south Florida market. Manages programmatic and business planning and development. Initiates, researches, and evaluates new business opportunities, including relationships, pricing models, services, operational structures, and network development opportunities. Develops and utilizes complex financial models to assess payer contracts, value-based arrangements, strategic partnerships, reimbursement methodologies, and new business opportunities. Directs financial analyses, reporting, performance monitoring, and cost-savings evaluations to support negotiations and business decisions. Develops and applies appropriate clinical, research and education metrics for the evaluation of business cases and programmatic activities and monitors strategic planning progress. Coordinates groups involved in the development of multi-disciplinary programs to support the most favorable proposition for the Health System as a whole. Initiates, conducts, and facilitates meetings with internal and external stakeholders to exchange information, resolve operational issues, develop strategic partnerships, evaluate new ventures, and support long-range planning initiatives. Serves as a liaison between internal and external stakeholders, managing communications, operational issues, strategic initiatives, and partnership opportunities. Coordinates efforts across departments and leadership teams to support organizational objectives. Develops business plan and integration strategies for community physician practices. Leads and manages staff responsible for network contracting, contract implementation and operations, non-participation agreements, provider roster management, reporting, and special projects. Oversees hiring, onboarding, training, mentoring, performance management, professional development, coaching, and disciplinary actions, as appropriate. Collaborates with internal peers and senior leaders, advising on medical economics and contract modeling, revenue cycle functions, audits and collections activities, and counsels medical department leadership on managed care protocols and strategy. Trains on new procedures, supplies, and pharmaceuticals being used for inclusion in the managed care contracting process. Oversees all stages of the hospital and physician managed care contracting process, including contract negotiation, implementation, operational readiness, payer communications, provider enrollment coordination, and ongoing contract performance monitoring. Executes and manages complex legal, financial, operational, and reimbursement contract negotiations with national, regional, government, and commercial payers. Develops and executes contracting strategies for all components of the health system, including hospital, physician, transplant, ancillary, specialty network, and other integrated healthcare services across fee-for-service and value-based reimbursement arrangements, including capitation, bundled payments, pay-for-performance, shared savings, shared risk, and full-risk agreements. Monitors and responds to insurance industry trends, healthcare reform initiatives, payer strategies, legislative and regulatory changes, payor policy modifications and competitive market dynamics to maintain and strengthen the organization's strategic position. Escalates, monitors, and manages payer operational issues identified through revenue cycle operations, Central Business Office activities, Joint Operations Committee meetings, and other governance structures. Collaborates with payer and organizational leadership to drive issue resolution and mitigate operational, financial, or legal risk. Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations. Creates an effective control environment, conducts risk assessment, implements, and monitors controls. Education: Bachelor’s degree in relevant field required Certification and Licensing: None Experience: Minimum 5 years of relevant experience required Knowledge, Skills and Abilities: Strategic Alignment: Skilled in aligning departmental goals with enterprise-wide strategy and develops comprehensive strategic plans. Financial Management: Ensures fiscal responsibility, and optimization of financial performance. Resource Management: Ability to allocate resources and drive innovation and growth. Adaptability: Proven ability to adjust to changes and leads/inspires transformational change. Team Leadership: Ability to build and lead high-performing teams, manage complex projects, and ensure successful project delivery. Technology & Analytics: Understanding of technology, data analytics, and performance measurement to drive strategic decisions and identify opportunities. Communication: Ability to influence others, articulate strategic vision, and ensure clear and persuasive communication. The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff The mission of the University of Miami is to transform lives through education, research, innovation, and service. A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation. The University comprises 12 schools and colleges serving undergraduate and graduate students in more than 350 majors and programs. Visit welcome.miami.edu/about-um to learn more about our points of pride. The University ranks No. 55 on U.S. News & World Report’s 2022 Best Colleges list and ranked No. 49 in the 2022 Wall Street Journal/Times Higher Education College Rankings. Bascom Palmer Eye Institute is ranked the #1 eye hospital in the USA and offers some of the nation's premiere eye doctors to treat every eye condition for adults. Sylvester Comprehensive Cancer, part of the Miller School of Medicine, received the prestigious National Cancer Institute designation in 2019. The University of Miami and UHealth have also ranked among the Forbes Best Employers and Best Employers for Women on several occasions, most recently in 2022. With more than 17,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
