Company Overview:

Easterseals UCP has been part of the fabric of North Carolina and Virginia for 75 years. We started in counties all over NC and VA filling gaps and addressing the needs of children and adults with disabilities. Our legacy organizations Easterseals NC, United Cerebral Palsy NC, and Easterseals Virginia joined forces as Easterseals UCP to intentionally work side-by-side with more than 20,000 individuals and their families, providing the broad network of services and support they need to achieve better days. Today we are affiliated with both Easterseals, Inc. and United Cerebral Palsy Inc. Our mission is to create opportunities, promote individual choice, and change the lives of children and adults with disabilities by maximizing their individual potential to live, learn, work and play in their communities.

Position Overview:

The Director, Contracts and Payer Relations functions primarily as the leader overseeing payer contracts and payer relations activities of Easterseals UCP North Carolina & VA (Easterseals) and serves as NCTRACKS Office Administrator (OA) or designee of OA. The Director, Contracts and Payer Relations is responsible and held accountable for building relationships with internal and external key stakeholders including internal departments (HR, Credentialing, Operations, Compliance, etc.) and Managed Care Organizations, commercial insurers, DMA and NCTRACKS. This person will ensure timely resolution of issues with payers through leading collaborative efforts and development of processes to exceed needs of agency. This Director leads and supervises the contracting team and directly manages agency contracts including but not limited to, maintenance, compliance and reporting.

The Director, Contracts and Payer Relations is responsible for staff development, training, monitoring and evaluation of contracts processes. This person functions within the Finance Department and incorporates continuous quality improvement throughout daily functions. This person will be able to retain and attract the right people and will hold self and others accountable. The Director, Contracts and Payer Relations provides highly competent and professional leadership to the people within his/her scope of responsibility and represents the organization in a positive and professional manner. External stakeholders as credible and reliable will view this director.

Job Duties:

  • Meets with senior staff on a regular basis to ensure synchronization with mission and vision,
  • Meets with direct reports regularly to ensure adherence to the strategic direction, establishing clear expectations for accountability and commitment to the mission, working towards implementation of health reform changes in NC and VA.
  • Develops and maintains strong relationships with key stakeholders in the community, with payers in both commercial and government sectors.
  • May negotiate agreements with payers.
  • Oversees review, approval and execution of contracts with payer sources.
  • Coordinates activities with the HR/Credentialing to meet payer obligations.
  • Provides internal training and technical assistance on contract agreements.
  • Logs and tracks all contracts, contract amendments and manages compliance reporting.
  • Ensures external and internal systems are updated to reflect changes.
  • Reviews and makes recommendations to Senior Leadership on payer contracts related to language, requirements and rates.
  • Maintains close working relationship with contract and credentialing staff among payer sources.
  • Provides support to programs to initiate contract amendments.
  • Requests contract changes/amendments as needed.

Leadership Competencies:

  • Action Oriented
  • Consistently maintains high levels of activity or productivity; sustains long working hours when necessary, works with vigor, effectiveness and determination over a sustained period.
  • Decision Making/Problem Solving – Conflict Resolution

Breaks down problems into components and recognizes interrelationships; makes sound, well- informed and objective decisions. Compares data, information and input from a variety of sources to draw conclusions; takes action that is consistent with available facts, constraints, and probable consequences. Uses appropriate interpersonal styles and techniques to reduce tension and/or conflict between two or more people; able to size up situations quickly; able to identify commons interests; facilitates resolution.

  • Strategic

Understands how an organization must change in light of internal and external trends and influences; understands the agency strategic plan and keeps the big, long-range picture in mind; builds a shared long-range organizational vision with others. Committed to a course of action to achieve long-range goals and influences others to translate vision into action.

Understands the need for and applies collaboration by using other staff as resources to attain common goals.

  • Guiding and Developing Staff – Coaching

Focuses on guiding others in accomplishing work objectives; rewards and recognizes others, both formally and informally, in ways that motivate them. Sets high performance expectations for team members; sets clear performance expectations and objectives; holds others accountable for achieving results. Successfully finds resources, training, tools, etc., to support staff needs. Works with staff to create developmental opportunities to expand knowledge and skill level; provides effective feedback and guidance for career development. Provides timely guidance and feedback to help others strengthen knowledge/skills areas needed to accomplish a task or solve a problem.

  • Accountable

Has the ability to establish specific, clearly stated expectations; committed to follow-through; is willing to hold direct reports, peers, self and supervisors accountable; has ownership.

Promotes an environment of ‘team’ in which staff are utilized in the most effective and efficient manner, pulling from their individual strengths to attain common goals.

Supervisory Responsibility:

The Director, Contracts and Payer Relations directly supervises staff who work on the team- this may cover NC and VA. The Director, Contracts and Payer Relations is responsible for the growth and development of the contracts team and provides relevant input to executive team.

Qualifications:

  • Educational requirements
    • The Cntracts and Credentialing Director will hold, at minimum, a Master’s Degree preferably with a concentration in Health Care Management or Business, from an approved, accredited institution. 10 or more years’ experience in management in payer/provider relations, payer/provider contracting or related field will be considered in lieu of a Master’s Degree.
  • Experience requirements
    • The Directr, Contracts and Payer Relations will have a combined minimum of 10 years of fulltime, supervisory and programmatic experience in the human services or health care field; and 5 years’ experience working with at least one of the following: Medicaid, Medicare, Private Insurance and Manage Care Organization (MCO) IPRS Billing.
  • Knowledge, skills, and abilities to negotiate effectively on state and federal policies, have considerable viable contacts in the industry and knowledge of the history of development of services and support systems in the industry. The individual shall possess knowledge and skills to establish collaborative relationships with other agencies and to navigate the legal organizational structures to operate services.
    • Knowledge of State and Federal Compliance standards.

Remote candidates with the right experience will be considered. Apply here.


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COVID-19 Risk Management Plan August 11, 2021

We are excited to return to sunny southern California for The 2021 OPEN MINDS Management Best Practices Institute at the picturesque Newport Beach Marriott Hotel & Spa, August 23-26, 2021. To help plan your in-person attendance, visit https://openminds.com/live-mbpi/ for a schedule of events happening throughout the week.

The resurgence of the COVID Delta variant has certainly created new challenges for the country and for our families. Fortunately, the available COVID vaccinations have been very successful in preventing symptomatic infections and illness. But I did want to let you know that our team at OPEN MINDS is committed to making our executive events as safe as possible and have an active risk management plan in place. I wanted to share with you the key elements of our plan:

We will continue to monitor any changes in the CDC recommendations for the continued safety of the public. If you have any concerns or questions, feel free to reach out to a member of our team at events@openminds.com or by phone at 877-350-6463. We look forward to seeing you at The 2021 OPEN MINDS Management Best Practices Institute.

Monica E. Oss
Chief Executive Officer
OPEN MINDS

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