Job Title 

Director of Managed Care

Location

Remote/Nationwide, USA

Employee Type

Employee

Working Hours Per Week

40

AtВ CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care.
В 

CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission.В 

SummaryВ 

вҖӢвҖӢThe Director of Managed Care will be responsible for evaluating, negotiating, credentialing, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations.

вҖӢSalary Range: $150,000 - $180,000 (DOE)

Schedule:В (Remote) Monday - Friday, 8:30am - 5:00pm

Location: Virtual, United States

Travel: This position is expected to travel up to 25 - 30% for various conferences, sales meetings, etc. with the longest being 4 weekdays at a time

Essential Duties and ResponsibilitiesВ В 

include the following. Other duties may be assigned, as necessary.В 

• вҖӢвҖӢвҖӢLeads the implementation process of managed care contracts and develops and maintain systems to disseminate contract information В 

• вҖӢManages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycleВ 

• вҖӢAchieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers В 

• вҖӢResponsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contractвҖҷs performance, and payer relationsВ 

• вҖӢResponsible for coordination and communication between managed care and other interested party departments and leadershipВ 

• вҖӢResponsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operationsВ 

• вҖӢOversight of payer credentialingВ 

• вҖӢWill assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contractingВ 

• вҖӢCommunicates with respective payers related to trends and compliance with contract parametersВ 

• вҖӢConsistently represents the company in a professional mannerВ 

• вҖӢMaintain effective working relationship and cooperate with all personnel in the CompanyВ 

• вҖӢAdheres to the CompanyвҖҷs compliance requirements as stated in the policy and procedure manual and all other related policiesВ 

• вҖӢPerform other duties and responsibilities as assignedвҖӢвҖӢВ 

Qualification RequirementsВ 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.В 

• Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contractsВ 

• вҖӢвҖӢвҖӢProvide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possibleВ 

• вҖӢMust possess the ability to multi-task and frequently change directionвҖӢвҖӢВ 

Education and/or ExperienceВ 

• вҖӢвҖӢBachelorвҖҷs Degree preferred or equivalent experienceВ 

• вҖӢAt least 2 yearsвҖҷ experience implementing contracted Third-Party programs in the healthcare industryВ 

• вҖӢMinimum two years in healthcare management manage care environment and administering contracts or equivalent experienceВ 

• вҖӢPreferred experience in managing, analyzing, and reporting denials and appeals.вҖӢВ 

Physical DemandsВ 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.В В 

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.В В 

Specific vision abilities required by this job include close vision and the ability to adjust focus.В 

Work EnvironmentВ 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.В В 

вҖӢвҖӢThis job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.вҖӢ While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.В 

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

CSI Pharmacy is an Equal Opportunity Employer