How You Will Make an Impact: The Director of Managed Care Contracting is a key member of CCRM Payer Strategy team as an individual contributor, coordinating all aspects of the contracting process This role impacts the organization by optimizing costs, minimizing risks, fostering strong partnerships, enhancing operational efficiency, ensuring compliance, and contributing to successful project outcomes. The Director of Managed Care Contracting is integral to achieving CCRM Fertility’s strategic goals and maintaining a competitive edge.

What You Will Do: . The Director of Managed Care is responsible for developing administrative and technical contracting strategies through development, negotiation, implementation of terms, and monitoring contractual agreements for the network. This role will oversee contract management including negotiation, analysis interpretation, implementation, maintenance of the contract performance, and developing payer relations. They will coordinate of all aspects of the contracting process and support company growth by developing new contracts with payers and expanding services with existing contracts. The position supports the entire contract process and closely collaborates with internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers. The Director of Managed Care Contracting will report to the Chief Revenue Officer.

• Perform full life-cycle Contract Management for a large portfolio of high value contracts.
• Provide technical expertise in developing, organizing, and processing contracts and facilitate the approval process of all contract documents from pre-contract through post signature phases.
• Develop and maintain periodic (e.g., bi-weekly) status reports on all contracts.
• Collaborate on new practice transitions by researching territories to identify gaps with our payer base and supporting the expansion into new markets; use results to make recommendations regarding participation or non-participation with new or existing agreements.
• Review, interpret, analyze, manage, negotiate complex agreements, resolve contractual issues, and ensure adherence to all contract language, financial guidelines, and parameters.
• Track and maintain financial performance and status for all contracts to monitor and coordinate financial analysis of payer contract performance and modeling projections.
• Utilize electronic tracking platform for repository, data collection, and reporting; ensure accurate data entry of contract specifications/terms and completeness of contracting processes.
• Develop and maintain processes to provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
• Maintain relationships with contracted providers and ensure contractual language is current; evaluate fee schedule to identify possible opportunities for additional covered services, medical policy changes, and reimbursement.
• Represent CCRM in cultivating business relationships with payers; utilizing communication and organizational skills to collaborate with payers to achieve common objectives.
• Develop and maintain productive working relationships with project team members, partners, clients, vendors, and other key stakeholders.
• Maintain knowledge of federal, state, and county policies and legal requirements.
• Collaborate with staff/contractors to ensure compliance with applicable laws/contract terms.
• Assist in producing and disseminating contract information to all relevant departments, identify and resolve problems with contracts regarding billing, claims payment, scheduling, registration, credentialing, service development, care management, and noncompliance.
• Respond to third party payers, employers, internal staff, and physicians in day-to-day customer service relations and problem resolution.
• Collaborate with operational departments to identify and implement appropriate changes in operating procedures and systems, required to accommodate payer contracts.
• Incorporate strategic business goals as presented by the CCRM Senior Leadership.
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
• Effectively and professionally, represent CCRM to the payer, provider, and patient community.
• Other duties as assigned.

What You Bring:

• Bachelor’s Degree or equivalent experience required.
• 5+ years’ contracting experience with hospital, clinic, physician, and or health system required.
• 3+ years’ experience with medical insurance company, MSO, IPA, TPA, preferred.
• Competent in healthcare industry, legal, and regulatory requirements required.
• Excellent contract negotiation skills required.

Working Conditions: The physical demands described here are representative of those which should be met, with or without reasonable accommodation (in accordance with ADA Guidelines), by an employee to successfully perform the essential functions of this job. This job operates in a professional office setting. While performing the duties of this job, the employee will interact with others, sit/stand at a desk, work on a computer, and spend prolonged periods preparing and analyzing data and figures. Employees will use standard office machines and equipment (computer, telephone, photocopier, and scanner).

CCRM’s Compensation: The salary range represents the national average compensation for this position. The base salary offered will vary based on location, experience, skills, and knowledge. The pay range does not reflect the total compensation package. Our rewards may include an annual bonus, flexible work arrangements, and many other region-specific benefits.

Pre-Employment Requirements: All offers of employment are conditional upon the successful completion of the CCRM Fertility onboarding process, including verification of eligibility and authorization to work in the United States. This employer participates in the E-Verify Program in order to verify the identity and work authorization of all newly hired employees.

Equal Employment/Anti-Discrimination: We are an equal-opportunity employer. In all aspects of employment, including the decision to hire, promote, discipline, or discharge, the choice will be based on merit, competence, performance, and business needs. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.