CSI Director of Managed Care (S)

Job Title 

Location

Employee Type

Working Hours Per Week

• Leads the implementation process of managed care contracts and develops and maintain systems to disseminate contract information
• Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
• Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers
• Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
• Responsible for coordination and communication between managed care and other interested party departments and leadership
• Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
• Oversight of payer credentialing
• Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
• Communicates with respective payers related to trends and compliance with contract parameters
• Consistently represents the company in a professional manner
• Maintain effective working relationship and cooperate with all personnel in the Company
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies
• Perform other duties and responsibilities as assigned

Qualification Requirements

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.

• Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contracts

• Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possible
• Must possess the ability to multi-task and frequently change direction

Education and/or Experience

• Bachelor’s Degree preferred or equivalent experience
• At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
• Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience
• Preferred experience in managing, analyzing, and reporting denials and appeals.

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.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

CSI Pharmacy is an Equal Opportunity Employer