CSI Pharmacy

Individualized therapies designed to be as unique as you.

Managed Care Regional Director

DirectorDirectorFull TimeRemoteTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

California

Posted

15 days ago

Salary

$150K - $180K / year

Bachelor Degree2 yrs expEnglish

Job Description

• Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region. • 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 payers 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 medical and pharmacy plans 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 relationships 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

Job Requirements

  • 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.

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