CTG Director, Managed Care in Chicago, Illinois

Title: Director, Managed Care

Location: US-IL-Chicago

Job Number: 18207659

The Director of Managed Care will facilitate and implement the managed care strategy as it pertains to integration, acquisition, and retention of managed care plan contracts.

Responsibilities:

  • Articulate value proposition and communicate test offerings to health plan contracting and medical teams

  • Secure coverage and reimbursement for new technology and focus tests

  • Work with health plans to improve coverage positions for tests

  • Reviews and respond to proposals and contracts

  • Negotiate pricing, execution, and implementation of contracts

  • Review managed care contracts from a financial and operational basis and work with business development, finance, and contract administrators in order to represent all interests in contract negotiations

  • Modify existing contracts to appropriately reflect operational policies, procedures and capabilities

  • Responsible for models for pricing review

  • Initiate programs and processes to retain current business and grow business in each contract, including maximizing pull through opportunities

  • Communicates to the division and management on the performance of managed care customers, including problems, concerns, and issues related to billing/customer service and reimbursement

  • Work with appropriate departments and managers to resolve issues

  • Analyze and monitors fees for managed care customers

  • Utilization review and analysis for capitation rate adjustments for capitated plans

  • Ensures regular price adjustments are implemented

  • Negotiate and implement pricing for years of coding, exclusions, and new technology

  • Develop and implement business plan for managed care with a focus on profitable contracts with strategic significance on an annual basis

  • Provide monthly update reports to management

  • Maintain regional managed care plan relationships focusing on regional anchor plan strategy

  • Responsible for relationships and communication with managed care plans

  • Verifies accounts are tracked in system appropriately and provides explanation of variations in accession volume and revenue.

  • Interact with all appropriate departments and sales personnel to ensure the proper handling and service of accounts

  • Works with billing supervisor to communicate contract specifics for new plans and changes in data requirements for existing plans to the field

  • Assists Contracts Administrator in conjunction with legal department on all contracts

  • Maintains company required records and make reports on all phases of activities

  • Research, troubleshoot and resolve service issues related to national accounts

  • Monitor service and performance of accounts including billing, pricing, systems requests, payment activity, reports, etc.

  • Work with reimbursements department and billing analysts to verify that fee schedules are reimbursed appropriately, rate changes are implemented, and A/R issues are identified

  • When reimbursement or claims transmission and processing issues are identified, negotiate and track issues until successfully resolved

Qualifications:

  • Bachelor's degree or equivalent combination of education and experience

  • Professional, articulate, and financially astute salesperson

  • Strong presentation skills and excellent negotiation, sales, analysis, communication, and PC skills

  • Must be able to serve as internal subject matter expert for managed care team

  • Knowledge of Principles of Managed Care, including plan types (HMOs, PPOs, etc.) and understanding of progressive health care dynamics, including risk-sharing, value based reimbursement, medical policy, and laboratory utilization management programs.

  • Must have understanding of capitated and fee-for service reimbursement arrangements, and knowledge of CPT and ICD-10 coding

  • 10 years managed care experience required, sales and lab background preferred

Qualifications:

CTG (NASDAQ: CTG) provides industry-specific IT services and solutions that address the business needs and challenges of clients in high-growth industries in North America and Western Europe. CTG also provides strategic staffing services for major technology companies and large corporations. Backed by more than 50 years of experience and proprietary methodologies, CTG has a proven track record of reliably delivering high-value, industry-specific staffing services and solutions to its clients. CTG has operations in North America, Western Europe, and India.

CTG's greatest asset is its people, and as such, we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work in Healthcare company by Modern Healthcare (2013-2016) in North America, and a Best Workplace in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Technology & Healthcare IT