Associate Director of Health Sciences Managed Care

Hiring Department: Managed Care

Location: Chicago, IL USA

Requisition ID: 1018449

Posting Close Date: May 24, 2023

About the University of Illinois Chicago

UIC is among the nation’s preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent “Best Colleges” rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has nearly 260,000 alumni, and is one of the largest employers in the city of Chicago.

Description:

About UI Health

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois at Chicago (UIC), UI Health comprises a clinical enterprise that includes a 495-bed tertiary care hospital, 22 outpatient clinics, and 13 Mile Square Health Center facilities, which are Federally Qualified Health Centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

This position will serve in a leadership capacity and be responsible for providing strategic oversight for all managed care credentialing, contracting and financial analysis of all Health Science Colleges. The role will be responsible for the execution of managed care and pharmacy contracts and pricing analytics, data integrity, contract profitability, auditing and reporting and recommendations. Leveraging all data sources to interpret managed care market information and provide insight to support contracting decisions. Create and maintain business critical models and reports supporting payer mix and pricing strategy. Responsible for ensuring Health Science's provider operations and regulatory requirements are met, ongoing end-to-end process improvement and increasing overall operational efficiency. Oversee the credentialing process for all eligible providers within the Health Science Colleges.

Duties & Responsibilities

• Ability to manage and lead numerous projects at the same time, especially large-scale projects
• Oversees the negotiation, contract review, financial analysis, contract finalization, approval and implementation process for all Health Science Colleges managed care contracts.
• Oversee all aspects of credentialing eligible providers for all Health Science Colleges.
• Responsible for developing positive and on-going working relationships with senior leaders within external partners and internal departments to assist in facilitating the goals and objectives of the Health Sciences Colleges.
• Oversees the development of initiatives for special projects which make health care services more accessible, affordable, and attractive to managed care companies.
• Develop collaborations across external managed care organizations and internal departments/Colleges to ensure deliverables and goals are met.
• Drive cross-functional analyses and build processes and deliverables to support knowledge sharing while providing insights based on industry knowledge of both government and commercial managed care payors and market trends.
• Selects, develops, manages and evaluates direct reports; and oversees the selection, development, management and evaluation of indirect reports. Participates in the training new staff and manages staff in day to managed care operations.
• Provides operational updates to senior management.
• Maintains professional affiliations to enhance knowledge.
• Other duties and responsibilities as assigned.

Qualifications:

Minimum Qualifications

• Bachelor’s Degree in Healthcare Administration, Business or related field required;
• Master’s Degree in Health Administration, Health Policy, Nursing, Business or other relevant field preferred
  
  A minimum of ten years’ progressive experience in managed care in an Academic Medical Center/hospital or clinic setting along with at least three (3) years of experience working at a Health Insurance Company.
• Demonstrated leadership ability including direct experience managing employees and staff development. Expansive understanding of health care insurance companies, pharmacy benefit managers and health care delivery systems. Direct experience with complex negotiations and contracting and managing capitation including PCP, partial risk and full risk, development of policies and procedures, claims processing & auditing, customer services, and provider relations. Extensive experience with hospital, physician, provider and pharmacy financial modeling and pro forma development within excel, access, work and project management.
• In-depth knowledge of health insurance contracting documentation, including familiarity with contract language and ability to develop appropriate negotiation strategy. Knowledge of healthcare industry on a national and local level and how factors can influence reimbursement to Hospital, Physician Group and Pharmacy.
• Knowledge of Medicare and/or Managed Care regulations and the International Classification of Disease (ICD-9) and the Current Procedural Terminology (CPT) systems of Coding. Solid knowledge of Hospital operations, such as Patient Accounts, Finance and Ambulatory Services
• Highly organized and able to quickly prioritize multiple assignments with high quality results. Exceptional communication (written and verbal) skills, including the ability to interact with a variety of external and internal audiences. Business understanding of Health care reform, healthcare exchange marketplace, Medicaid expansion, Mandatory Medicaid and timelines. Ability to manage multiple projects and project time constraints. Contract negotiation experience and skills. Problem solving skills.

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation