Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.
Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).
Education
- Bachelor’s degree in healthcare administration, business administration or finance, or equivalent experience required.
- Master’s degree in healthcare administration, business administration, or related field preferred
Experience / Qualifications
- Minimum of seven years’ experience in managed care and healthcare administration, working with third party payers and managed care organizations is required.
- Keen negotiating skills and contract management skills.
- Experience with data analysis and financial modeling.
- Excellent analytical skills and problem-solving abilities, including the ability to interpret complex data and drive data-driven decisions.
- Knowledge of hospital and managed care finance, as well as healthcare regulations and compliance standards, including HIPAA and CMS guidelines.
- Excellent communication and interpersonal skills, with the ability to effectively collaborate with various stakeholders both internally and externally.
- Strong written and verbal communication skills and experience with formal presentations.
- Team player with proven ability to develop strong working relationships with stakeholders across all levels of the organization.
- Demonstrated leadership ability to build teams, develop talent, and foster a culture of collaboration.
- Excellent project management skills and demonstrated ability to prioritize and oversee multiple initiatives.
- Ability to maintain confidential and company proprietary information.
Position Summary
Director of Managed Care strategically leads the team that is responsible for negotiating payer agreements on behalf of Jupiter Medical Center. The Director participates in the development, negotiation, implementation, monitoring and management of all third-party payor contracts. Director will develop and maintain a network of relationships with third party payors, establish and maintain effective relationships with executives, operational leaders, as well as colleagues and peers within revenue cycle and finance.
- Develop and implement the strategy, objectives, techniques, and tactics to achieve the strategic goals of the Organization.
- Collaborate with cross-functional teams to negotiate contracts and analyze provider networks, ensuring optimal value and quality.
- Strategically assess various contract relationships to determine appropriate changes based upon local market dynamics.
- Evaluate managed care contracts, performance, and reimbursement rates to identify areas for improvement.
- Stay abreast of changes in healthcare regulations and industry trends, and recommend adjustments to managed care strategies that anticipate changes that are forthcoming.
- Oversee the development and maintenance of provider relationships, fostering open communication and collaboration.
- Lead and mentor a team of managed care professionals, providing guidance, coaching and support to develop a team rooted in excellence and forward thinking.
- Analyze data and financial metrics to identify opportunities for cost savings and process improvements.
- Interface with executive leadership to provide regular updates, reports, and recommendations related to managed care strategies.
- Collect, organize, and timely submit all credentialing requests.
- Manage contracting for hospitals, physician, and ancillary providers.
- Assist in auditing of payments collaboratively with other departments to address and resolve operational issues as it relates to negotiated contract language.
- Prepare, analyze, review, and project financial impact of provider contracts and alternate contract terms.
- Develop the strategy to incorporate the delivery and reimbursement for new technologies into existing and future contracts.
- Understand and enforce all hospital and personnel policies and procedures.
- Perform other duties as assigned.
Leadership Competencies
Establishing Relationships
Builds effective networks, working relationships, and alliances with a broad range of stakeholders (both internal and external) in order to collaborate effectively within divisions and across boundaries. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.
Developing Talent
Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively.
Inspiring and Motivating Others
Fosters commitment and cohesiveness by motivating, guiding, and facilitating cooperation within the department toward goal accomplishments. Can persuade others, build consensus, and ensure cooperation from others to gain genuine acceptance to accomplish “win-win” solutions.
Demonstrating Emotional Intelligence
Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.
Acting with Integrity
Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.
Acting Strategically
Aligns day to day activities around broader organizational goals and objectives; prioritizes resources based on the strategic objectives of the organization.
Being a Champion for Change and Innovation
Supports people in their efforts to try new things. Generates novel and valuable ideas and uses these ideas to suggest new or improved processes.
Communicating Effectively
Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and across the organization.
Promoting Diversity and Inclusion
Treats all people with dignity and respect by being fair and consistent. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenge’s bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.
Holding Self and Others Accountable
Sets clear performance expectations and objectives for self and others; evaluates work performance and provides feedback when needed. Accepts responsibility and accountability.
Physical Requirements
Requires sitting for long periods of time, also stooping, bending, standing, and stretching. May require lifting up to 20 lbs. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push/pull up to 40lbs., carry and lift up to 20lbs.
Threshold Requirements
- These threshold requirements are required and completed yearly basis.
- Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation.
- TB/PPD Surveillance Program
- Maintenance of required professional licensing and/or certification(s).
