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Kalispell Regional Healthcare Director, Managed Care and Population Health in Kalispell, Montana

Overview

The Director, Managed Care and Population Health reflects the mission, vision, and values of KRH, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities

The role of the Director, Managed Care and Population Health (“Director”) is to develop a contracting strategy that maintains or enhances contract profitability, maintains market share, monetizes KRH’s population health initiatives, and adds new volume for Kalispell Regional Healthcare health system (KRH) consisting of two acute-care hospitals (Kalispell Regional Medical Center, and North Valley Hospital), a skilled nursing facility (Brendan House), a fitness facility (The Summit Medical Fitness Center), a mental health and substance abuse facility (Pathways Treatment Center), a durable medical equipment company (Kalispell Medical Equipment),more than 30 primary and specialty physician clinics and any future entities of KRH. The Director negotiates and/or supervises a team of contractors and/or analysts who negotiate favorable contract terms with managed care payors under both Fee-for-Service and Value-based reimbursement arrangements. The Director leads and supervises the negotiation of all managed care payor contracts, including Commercial, Medicare Advantage and Managed Medicaid products. The Director will manage and grow payor relationships and facilitate regular meetings with the payors to ensure alignment with KRH strategies and objectives. The Director is responsible for planning and implementing the KRH managed care and population health strategy in conjunction with the Executive Director, Revenue Cycle.

Additionally, the Director is instrumental in the design and implementation of key Population Health strategies and objectives aimed to improve health outcomes, reduce health care spend, and improve quality and patient experience for KRH. The Director collaborates with the population health team and system leaders to develop and support financially sustainable population health initiatives system wide.

Qualifications

  • Bachelor's Degree, preferably in Business Administration or Health Administration.

  • Master's Degree or equivalent experience.

  • Must have a strong track record in negotiating hospital and physician managed care contracts.

  • A minimum of seven (7) plus years’ experience in managed care contract negotiations, including some knowledge of hospital/physician contract negotiations, including value-based arrangements.

  • Solid knowledge of financial and decision support analytics and contract modeling.

  • Strong hospital, physician and payor relationship skills.

  • Proven negotiation skills, contract language review skills, marketing and financial effectiveness.

  • Strong ability to consistently prepare and review accurate analyses, projections, and rate proposals.

  • Solid understanding of Medicare and Medicaid programs.

  • Experience with ancillary provider contracting (home care, rehab, SNF, hospice, etc.)

  • Possess strong interpersonal and communication skills with the ability to deal effectively with customers, peers, and leadership.

  • Strong organizational skills with a demonstrated ability to manage multiple tasks, activities, and priorities.

  • Experience working with cross-functional teams in complex organizations on complex program.

  • High degree of effective oral and written communication skills.

Job Locations US-MT-Kalispell

Requisition ID 2021-9903

Category Management

Pay Period Status 80

Shift Days

Schedule M-F

Position Type Full Time (Benefits Eligible)

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