Managed Care Regional Director

Job not on LinkedIn

🕒 March 1

🏄 California – Remote

🏄 California – Remote

💵 $150k - $180k / year

⏰ Full Time

🔴 Lead

👔 Director

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CSI Pharmacy

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧬 Biotechnology

Healthcare Insurance • Pharmaceuticals • Biotechnology

CSI Pharmacy is a nationwide specialty pharmacy that focuses on providing services and therapies for patients with chronic and rare illnesses requiring complex care. Founded by pharmacists, the company is dedicated to improving the health and lives of its patients by offering individualized infusion therapies, specialized pharmaceutical knowledge, and passionate patient advocacy. With a presence across the country, CSI Pharmacy offers services such as nursing, pharmacy services, insurance and reimbursement navigation, and patient advocacy, aiming to treat each patient with personalized attention. The company specializes in treating rare diseases with biologics and plasma-derived therapies and is committed to optimizing patient outcomes in the comfort of their homes.

📋 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

🎯 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.