Managed Care Finance Director jobs in Illinois

• Integrity – Must be trustworthy and principled when faced with complex situations.
• Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required.
• Communication – Ability to generate concise, compelling, objective and data-driven reports.
• Teamwork – Working well with others is required in the Fund’s collaborative environment.
• Diversity – Must be capable of working in a culturally diverse environment.
• Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise.
• Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

PURPOSE

This position is responsible for all managed care contracting and vendor administration (MCVA) activities for the Aurora-based Plan Units and collaborates with the Las Vegas-based Hospitality Plan on their vendor activities. Key accountabilities in this role include:

• Working with executive leadership and operational management to develop and manage MCVA’s strategic goals and operational deliverables
• Provide expertise in innovative contracting and explore new opportunities to increase quality and decrease cost
• Coaching and directing the Aurora-based MCVA Team that manages day-to-day contractual relationships with vendors and plays a key role in contracting

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Responsible for the strategic direction, planning, and management of managed care vendor contracting and monitoring
• Keeps informed on, negotiates and implements new strategies for innovative managed-care vendor and provider contracting such as direct contracting, risk sharing, narrow networks, and bundled payments, as well as unique contracting methodologies, such as contracts with providers at Health Centers and value-based contracting
• Employs consultants strategically and engages with experts in the field in order to identify opportunities
• Supervises and provides leadership and direction to the team of MCVA staff for the Aurora-based Plans Units and collaborates with the Las Vegas-based Hospitality Plan management, providing expertise and guidance
• Leads the administration, coordination, negotiation, and execution of all managed-care vendor and provider contracts and amendments
• Oversees relationship management of Aurora-based Plan Unit vendors and providers, identifying trends and resolving escalated issues in a timely manner
• Provides direction on the analysis of contract performance from utilization, financial, operational and member service standpoints for the Aurora-based Plan Units and collaborates with the Las Vegas-based Hospitality Plan on their activities
• Coordinates vendor-issue resolution and implementation efforts with departments that support the Aurora-based Plan Units and Las Vegas-based Hospitality Plan, such as Operations, Claims, Legal, and Underwriting
• Responsible for the management of the Trustee Service Provider Resolution (SPR) process for the Aurora-based Plan Units and collaborates on the Las Vegas-based Hospitality Plan SPR process, including managing or collaborating on all related deliverables and deadlines
• Manages the Fund’s Service Provider Vendor Bid Process and Vendor Monitoring Program for the Aurora-based Plan Units and works in collaboration with the Las Vegas-based Hospitality Plan on their related bid and monitoring activities. Is creative about how and when to use RFIs and RFPs to identify new opportunities as well as to extract the most out of incumbent vendors
• Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints
• Supervises, leads, and delegates work and coaches, mentors, develops employees
• Analyzes problems, identifies, and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions
• Recommends hires and promotions, directs, and evaluates employment decisions for all assigned positions
• Assists with developing and coordinating policies and procedures
• Responsible for the oversight of continued employee training requirements, safety, and quality initiatives
• Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct with employees; partners with Healthcare Delivery & MCVA leadership and staff to create a safe and inclusive culture with equitable opportunities for success and career growth.
• Exemplifies the Fund’s BETTER Values in leading and fostering a respectful, trusting, and engaged culture of diversity and inclusion
• Takes actions that promote attracting, hiring, retaining, and motivating a diverse and inclusive workplace
• Maintains knowledge of diversity-related issues, legislation, best practices, and metrics
• Performs other duties as assigned within the scope of responsibilities and requirements of the job
• Performs Essential Job Functions and Duties with or without reasonable accommodation[BH1]

ESSENTIAL QUALIFICATIONS

Years of Experience and Knowledge

• 10 – 12 years or more of experience in a healthcare, managed care, or insurance organization
• Requires an excellent understanding of, and experience in leading, contracting efforts of the full range of managed care and healthcare approaches, including innovative models such as risk-sharing arrangements and capitation, as well as more unique and/or direct-provider arrangements including ancillary contracting efforts
• Strong working knowledge of current legislative requirements under ACA, COBRA, HIPAA, DOL, etc. as related to health benefits, eligibility, payment, appeals, etc.
• Strong data and financial analysis acumen and experience
• Strong report writing and presentation experience
• Demonstrated strong leadership and interpersonal skills to lead others to achieve results in a team-oriented environment
• Knowledge of an experience working with union or Taft-Hartley Trust Funds are pluses

Education, Licenses, and Certifications

• Bachelor's degree in Business, Healthcare Administration, related field or equivalent work experience required
• Preferred: Master’s degree

Skills and Abilities

• Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
• Intermediate level Microsoft Excel skills
• 15% ~ 25% travel required based on business needs
• Strong on initiative, innovation, and motivation
• Strong collaboration and teamwork skills
• Strong contract review and analysis skills
• Strong problem-solving and analytical skills
• Strong financial analysis skills
• Strong project management skills
• Strong verbal and written communication skills
• Strong management and leadership skills
• Experienced in coaching and developing staff

• 
  Salary range for this position: $133,300.00 ~$173,200.00. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
• Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week).
• Benefits: We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).