Director of Managed Care - East Brunswick, New Jersey
University Radiology, the largest provider of subspecialty radiology and teleradiology services in NJ, is comprised of over 140 Board Certified radiologists with advanced U.S.-based training and expertise in all modalities and all subspecialty areas. Our focus is on providing the highest quality subspecialty diagnostic care for our patients, referring physicians, hospitals and our healthcare clients. The more subspecialists driving this focus, the better the quality of care.
In operation for more than 50 years, University Radiology staffs, manages and provides preliminary and final subspecialty interpretations and consultative support for 10 affiliated regional healthcare centers and for our own 22 medical imaging centers. In addition, University Radiology serves as the academic radiology faculty at Rutgers Robert Wood Johnson Medical School. Our physicians interpret over 1.8 million radiology procedures per year providing 24/7/365 coverage/interpretation services.
Reporting to the Chief Revenue Officer, the Director of Managed Care is responsible for evaluating, negotiating and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations on behalf of University Radiology Group and its related entities. The position will maintain or establish strong relationships with the payor representatives in contracting and network support. Under the leadership of the CRO, the position will support the development of managed care strategies and initiatives for URG to adapt to ongoing healthcare payment reforms and evolving payment methodologies and to support the Practice’s strategic initiatives. The Director will also serve as a resource to support and resolve ongoing operational and revenue cycle issues with respect to Office and Hospital services.
- Strong knowledge of Revenue Cycle functions of a large physician practice in Imaging Office and Hospital settings.
- Fosters professional relationships with private and public payor management representatives and serves as the principal liaison between URG and payors, regarding contract changes and dispute resolution.
- Negotiates contract language and facilitates review from legal counsel and Administration and negotiates and administers single case agreements.
- Communicates relevant payor contract information to URG staff members, including Patient Financial Services, Patient Access and Marketing, and participates in periodic meetings advising on the changes within the payor contracts or healthcare industry.
- Establishes schedules for contract renewals and timing of renewal analysis in advance of the renewal date and assures new rates are accurate on their effective date, based on subsequent claims review.
- Functions as the subject matter expert for all payor contract inquiries from URG staff, Administrative leadership and physicians.
- Works with Manager of Credentialing to assure all credentialing and re-credentialing matters are addressed in a timely and efficient manner for all URG provider sites.
- Assures all fee schedules are maintained and current within Medinformatix.
- Serves as a resource for assessing managed care impacts in merger situations.
- Bachelor’s degree required with 7-10 years’ experience in a managed care environment, health insurance industry or managed care product development/negotiations, preferably in a physician practice setting.
- Extensive experience with contract negotiations and payor relations, as well as demonstrated knowledge of legal, regulatory and operational aspects of managed care, including contract management compliance and performance analysis.
- Experience and familiarity with physician/professional service fee schedules and resource-based relative value scale (RBRVS) based reimbursement.
- Strong leadership skills - Adaptable, approachable, diplomatic, impeccable interpersonal, managerial and leadership skills.
- Ability to work in a large physician-owned and led organization, promotes a culture of collaboration between all levels within the department and serves as a positive role model for the organization.
- Proficient in Microsoft Excel.
- Strong analytic and critical thinking skills.
- Solid understanding of revenue cycle functions, including patient access and patient accounting tasks, which include billing, collections and reimbursement analysis.
- The ability to communicate effectively with staff, physicians and management personnel within both the organization and the payor community.
University Radiology offers a comprehensive benefits program including medical, dental and life insurance, 401k/pension, and profit-sharing plans, generous paid time off policy and more.
Join our growing practice!