Director - Managed Care, Contracts, & Credentialing

  • Location
    Albuquerque, New Mexico
  • Category:
    Mid-Level Management - Management - General
  • Job Type:
    Direct Hire
  • Job reference:
    US_EN_8_849191_2801478
  • Salary:
    $ 100000 - $ 130000

Parker + Lynch is recruiting for a Director of Managed Care/Contracts & Credentialing.  This role is supervising a team up to 6 people.  The focus of this position is overseeing the management and negotiate of contracts with managed care organizations – both private and hospital.  You will be able to work remotely and should have the ability to work remotely much of the time going forward.  Our client is only considering candidates that live in or are moving to New Mexico.  Excellent benefits offer with a target salary of 130k + 10% annual bonus.  

Job Duties Include: 

  • Responds to, initiates, and evaluates requests for managed care contracts for multiple product lines and venues
  • Make recommendations to leadership on appropriate courses of action
  • Initiates and leads joint operation committees with designated major contractors to facilitate contract implementation and compliance
  • Identifies, analyzes, and evaluates contractual compliance issues as they arise
  • Resolve or facilitate resolution of compliance-related problems among partner/vendors as appropriate
  • Reviews, negotiates, writes, and processes contracts as related to the wide variety of services provided by managed care organizations
  • Serves as subject matter expert for managed care contract planning, reimbursement, interpretation, implementation, and maintenance
  • Directs the development of a managed care utilization, reimbursement, and contract database, producing and evaluating contract performance reports, modeling facility and professional (medical and dental) reimbursement rates, evaluating financial contract modifications, and compiling and monitoring key managed care statistics
  • Directs all provider database functions and the Medicare/Medicaid provider enrollment process
  • Manages receipt of credentialing applications, performs review, analysis and prepares files for review with recommendation to the medical staff
  • Manage the coordination and maintenance of the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE), re-appointment peer review process
  • Assists in clinical privilege development, maintenance, and periodic reviewed specialty specific clinical privilege criteria and documents
  • Facilitate the Credentialing Workgroup process with oversight of agenda and meeting packet preparation including supporting documentation, minute taking, and credentials summary preparation, information, and follow-up on items for POC and Board of Directors.
  • Ensure continued compliance with regulatory and accreditation agencies; AAAHC, CMS, NCQA, DOH, Federal and State laws and standards as they relate to Credentialing and Privileging.
  • Ad hoc tasks as needed
  • Job Requirements Include:

  • Bachelor’s degree in business or related fields
  • 10+ years of directly related experience
  • 5+ years of current management/leadership
  • Strong information systems and finance system knowledge/abilities
  • Advanced Excel, Access and PowerPoint skills
  • Other Requirements:

  • Satisfactory completion of background check and fingerprinting
  • Current vaccinations to include annual TST, Tdap and Hep B and annual influenza
  • Our client is looking to hire quickly.  Please apply for send your resume directly to me for immediate consideration at megan.mcquay@parkerlynch.com.  All discussions are confidential! Not what you are looking for? Check out our other open positions at the Albuquerque Parker + Lynch website: https://www.parkerlynch.com/



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