SSM Health Regional Director - Managed Care MO/IL in St. Louis, Missouri
This position is responsible for leading managed care strategy development and/or implementation, negotiations, management and implementation of the Hospital Organization, Physician Organization, PHO and CIO managed care contracting process for the SSM Health.
Takes forward managed care contracts within SSM Health in order to build consensus with regional MCC committees on direction and subsequently negotiate with payor executives to conclusion. Managed Care Contracts negotiated include traditional fee-for-service and value based contracts with commercial, Medicare Advantage, Medicaid HMO, Tricare and direct to employer payers.
Responsible for the overall operations and performance of SSM Health's PHO and SSM Managed Care Organization in the region, which includes network development, data base management and overall direction.
Leads and oversees negotiation of managed care payer contracts for SSM/MCO provider entities in the SSM Health OK Region. Fosters good working relationships with managed care plan executives to ensure good communication and results for SSM Health.
Leads and attends meetings including but not limited to MCC Regional Managed Care Contracting committees; CIO Board and Payor Relations Committees; MCO Board of Directors; ExclusiveChoice Operations; MCO Staff and other ad hoc as appropriate
Implements process improvements with the MCO Operations, Managed Care Contracting Process, and other areas of SSM Health as appropriate.
Leads strategic initiatives that affect the managed care contracting process (i.e. new services to be added to contracts or additional provider sites).
Responsible for staying up to date on managed care trends and makes recommendations to SSM Health’s Managed Care Organization in anticipation of, or in response to, changing managed care environment.
Assists others as appropriate.
Bachelor’s degree in healthcare of related field
At least 8 years of progressive experience with managed care environment; experience in contract negotiations; work with Commercial, Medicare Advantage, Medicaid HMO, TriCare and Direct to Employer is preferable.
At least 5 years of management experience
Experience in managing projects involving the collaboration, motivation and cooperation of a wide variety of people with whom there is no direct reporting relationship.
SSM Health - System Office –
SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.
Our Mission: Through our exceptional health care services, we reveal the healing presence of God.
Our robust employee benefits package includes health benefits, life and accidental death and dismemberment insurance, long-term disability coverage, health and dependent care reimbursement accounts, paid time off, tuition reimbursement, adoption reimbursement, an employee assistance program, retirement plan options and more.
Note: not all benefits apply to all openings.
Primary Location: Missouri-St. Louis-SSM Health System Office - 10101 Woodfield
Work Locations SSM Health System Office - 10101 Woodfield 10101 Woodfield Lane St. Louis 63132
Organization SSM Health - System Office
Schedule Full Time, Days
Normal work hours 8am-5pm
Scheduled Hrs Per Pay Period 80
Posting Nov 7, 2018, 3:22:38 PM
Req ID: 18014506