Director Managed Care at Fresenius Medical Care

Franklin, Tennessee, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

In-depth knowledge of organizational objectives, managed health care programs (HMOs, PPOs, POS, etc.), and company-wide policies and procedures
Expertise in financial analysis, cost-benefit evaluation, utilization review, and contract negotiation with managed care organizations and third-party payors
Knowledge of FMCNA products, services, strategies, community healthcare market, and industry issues
Ability to develop, modify, and execute policies affecting operations
Skills in strategic planning, regional marketing, quality improvement projects, and report card design
Experience with credentialing processes, compliance requirements, clinical and quality outcomes measurements, and third-party payor compensation structures
Willingness to travel as necessary (monthly)
Supervisory skills for hiring, coaching, counseling, performance reviews, disciplinary action, and terminations

Responsibilities

Direct strategic planning, evaluation, coordination, and implementation of managed health care programs
Oversee contractual relationships with managed care organizations and third-party payors, including rate structures, clinical/financial reporting, business terms, facility updates, and amendments per FMCNA Guidelines
Develop and direct regional marketing efforts to third-party payors to support growth and profitability
Manage tactical execution of short- and long-term objectives, including costs, methods, staffing, and results accountability
Review and analyze potential contracts for financial impact, cost-benefit, and utilization
Negotiate contractual relationships, present proposals, market/industry analyses, and respond to Requests for Proposals
Manage activities for delivery system contracts
Ensure facilities comply with managed care organization requirements, implement credentialing processes, and maintain appropriate licenses
Develop and implement methods/procedures for monitoring work activities and report status to management
Maintain continuous communication/coordination of documentation with staff
Work with internal/external counsel to resolve issues and support FMS
Negotiate/implement contracts requiring clinical/quality outcomes measurements
Contribute to design/implementation of third-party payor compensation structures
Assist in developing report cards illustrating patient care quality and ensure accurate/timely reporting of outcomes
Assist with designing Quality Improvement Projects for facilities not meeting goals
Develop/implement regional marketing plans for growth, profitability, and marketing FMS services
Manage department budget, day-to-day functions, develop budgets/schedules/performance standards, and supervise costs/methods/staffing
Implement/achieve business plan, budget, key performance indicators, and communicate to executives
Interact with internal departments/external customers/vendors for problem resolution
Provide technical guidance and assist with various projects as assigned
Other duties as assigned

Skills

Managed Care

Contract Negotiation

Strategic Planning

HMO

PPO

Financial Analysis

Marketing

Credentialing

Compliance

Rate Structures

RFP

Utilization Review

Third Party Payors

Fresenius Medical Care

Provides dialysis and renal healthcare services

About Fresenius Medical Care

Fresenius Medical Care North America focuses on delivering high-quality healthcare services to individuals with kidney and other chronic conditions. The company operates a vast network of dialysis centers and outpatient labs for cardiac and vascular care, ensuring coordinated treatment for many patients across the continent. It stands out as the largest fully integrated renal company, providing not only dialysis services but also specialty pharmacy and laboratory services. Additionally, Fresenius manufactures and distributes a wide range of dialysis equipment, disposable products, and renal pharmaceuticals. The goal of Fresenius Medical Care is to enhance the quality of life for patients with chronic illnesses by providing comprehensive and accessible healthcare solutions.

Waltham, MassachusettsHeadquarters

1996Year Founded

$39.1MTotal Funding

LATE_VCCompany Stage

Biotechnology, HealthcareIndustries

11-50Employees

Benefits

Professional Development Budget

Conference Attendance Budget

Flexible Work Hours

Risks

Increased competition from telehealth solutions like Philips' eCareManager 4.1.

Rising mental health challenges may impact FMCNA's employee productivity.

Virtual reality education may face adoption and accessibility challenges in rural areas.

Differentiation

FMCNA is the world's largest fully integrated renal company.

FMCNA offers a comprehensive line of dialysis equipment and renal pharmaceuticals.

FMCNA provides coordinated healthcare services at pivotal care points for chronic conditions.

Upsides

Telehealth market growth supports FMCNA's remote patient monitoring services.

Home dialysis market expansion aligns with FMCNA's patient-centric care approach.

AI integration enhances FMCNA's predictive analytics and personalized medicine capabilities.

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