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Director PHO Managed Care

Req #:  125420
Facility:  Good Samaritan Hospital
Department:  Management/Supervisory
City:  Downers Grove
Posting Budget Status:  Day
Shift Type:  Full Time - Permanent
Posting FTE:  1

Position Requirements:

  • Bachelors Degree 
  • 5-7 year's marketing/operations/finance experience 
  • 3 years in a managed care environment.
  • 3 years experience in negotiation of managed care contracts.
  • Demonstrated oral presentation and report writing skills.
  • Working knowledge of financial analyses, cost accounting and reimbursement method.
  • Demonstrated knowledge of managed care principles.
  • Good negotiation skills.
  • Competent product management skills.
  • Knowledge of hospital and physician (multi-specialty group, IPA or PHO) operations and services impacted by managed care.
  • Knowledge of the managed care industry.
  • Knowledge of various reimbursement methodologies for both physicians and hospitals.
  • Working knowledge of PC and applications software.
  • Competent written and verbal communication skills
  • Self-motivated, highly organized, extroverted, positive professional relationship skills, detailed


Purpose:
Direct activities of PHO sites, review the Member Revenue financial performance (all references to financial performance imply Member Revenue financial performance) and Utilization data of the PHO and identify potential performance enhancement opportunities, working with PHO Treasurers, Medical Directors, and AHP VPs of Operations, Quality Management, and Finance to enact strategies to realize PHO Board's identified opportunities. Utilize financial reporting information system to analyze financial and operational performance of PHOs. Assist PHOs in development of contracting strategies, in conjunction with Contracting Directors. The incumbent will be based at the PHO site (Good Samaritan Hospital) roughly 60% of the time, with the other 40% split between the Downers Grove Support Center and Advocate Health Partners (AHP) HQ in Rolling Meadows.  Incumbent is responsible for recommending various financial and medical management strategies and managing activities of the day-to-day operations of the PHO and its Board of Directors. The incumbent will also serve as the principle managed care resource to the PHO Boards, and system level AHP committees, Vice Presidents of Finance, and site executives and managers.

Accountabilities:

  1. Oversight of PHO Financial and Medical Management Performance
  2. Oversight of PHO Activities
  3. Subject Matter / Content Expertise (to support all PHOs)
  4. Liaison Role between AHP, PHOs, and Sites


Nearest Major Market: Chicago