Managed Care Regional Director

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🕒 Março 1

🏄 California – Remoto

🏄 California – Remote

💵 $150.000 - $180.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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CSI Pharmacy

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

💊 Farmacêutico

🧬 Biotecnologia

Healthcare Insurance • Pharmaceuticals • Biotechnology

A CSI Pharmacy é uma farmácia especializada de alcance nacional que foca em fornecer serviços e terapias para pacientes com doenças crônicas e raras que requerem cuidados complexos. Fundada por farmacêuticos, a empresa é dedicada a melhorar a saúde e a vida de seus pacientes oferecendo terapias de infusão individualizadas, conhecimento farmacêutico especializado e defesa apaixonada dos direitos dos pacientes. Com presença em todo o país, a CSI Pharmacy oferece serviços como enfermagem, serviços farmacêuticos, navegação por seguros e reembolsos, e defesa do paciente, visando tratar cada paciente com atenção personalizada. A empresa é especializada no tratamento de doenças raras com biológicos e terapias derivadas do plasma e está comprometida em otimizar os resultados dos pacientes no conforto de suas casas.

Descrição

• 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

🎯 Requisitos

• 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.