The Director, Managed Care actively participates in the planning, developing, and managing of strategies that support the managed care business of Memorial Health Services for the purpose of contributing to the financial growth and success of MHS. This position provides expertise on the impact of managed care to the strategic position of MHS relative to hospital competitors, physician groups, and managed care organizations (MCOs) present in its geographic market.
The Director is also directly responsible for overseeing the managed care function and operations at Saddleback and Orange Coast Medical Centers as well as directing specific managed care functions for MHS as assigned. The Director is also responsible for negotiating Hospital Based Physician contracts at SM/OC, as well as Medical Directoships/call coverage contracts in conjunction with the Chief Financial Officer.
The Director will be responsible for assisting in the implementation of the contracting activities associated with the MemorialCare Medical Foundation as needed.
Principal Duties and Responsibilities:
Activities include: Directing the managed care of SMC/OCMC to meet the local needs of the hospital and it’s specific marketplace. Planning, conducting and directing negotiation of system-wide contracts with Managed Care Organizations to maximize access to MHS Medical Centers by physicians and patients, and to maximize profitability to MHS and it’s Medical Centers. Implementing activities to support system-wide strategies with physician groups including IPA development, IPA contracting, Medical Foundation, hospital based physicians and physician relations. Participating in the Budgeting process for MHS Medical Centers to support the development of goals related to managed care revenue and expense contracts. Controlling the budget for the SMC/OCMC Managed Care Department. Managing, guiding and establishing accountabilities for staff of applicable departments for MHS and SMC/OCMC in support of local and system objectives