Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 47 distinct markets across 16 states, CHS is committed to helping people get well and live healthier. CHS operates 79 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

Summary:

The Regional Director of Managed Care is responsible for negotiating third-party payor contracts for hospitals, ASC’s, and free-standing ancillary locations across a multi-state territory, for developing strategies for contracting purposes to support market share and revenue growth goals, and working with other corporate and market stakeholders encompassing revenue cycle, compliance, business development, marketing, legal, clinical, and finance functions and areas.

Essential Duties and Responsibilities:

• Negotiate contracts for hospitals with third-party payors, for all types of commercial and government products and programs, including direct-to-employer contracting
• Manage existing payor contracts and relationships
• Monitor and manage payor contract renewals and renegotiations
• Negotiate contracts with new payors in each market
• Work closely with departmental financial analysis team to model reimbursement rate proposals
• Monitor market trends among payors and competitors, including narrow networks, new products, value-based agreements and programs, and adjust strategies to adapt to ongoing changes
• Coordinate with Physician Contracting Directors on payor strategies and contract negotiations, customized for each market
• Work with local and regional operations and clinical leadership to maximize performance on payor incentive programs
• Work to achieve individual, departmental, and enterprise goals for improving revenue
• Develop and maintain a close, working relationship with regional and market leadership

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reasoning Ability:

• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Computer Skills:

• To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities:

• This position does not have supervisory responsibilities

Education/Experience:

• Bachelor’s degree in related healthcare field required, Master’s degree preferred
• At least five (5) to seven(7) years of contracting experience, including contract language and reimbursement rates