UW HEALTH JOB DESCRIPTION
Director, Managed Care Contracting
Job Code: 113003
FLSA Status: Exempt
Mgt. Approval: M. Johnson
Date: October 2023
Department: Managed Care Contracting
HR Approval: B. Haak
Date: October 2023
JOB SUMMARY
The Director of Managed Care Contracting is responsible for the direction and leadership of operational, financial,
programmatic and employee related activities for Managed Care Contracting. This includes establishing, meeting and
continuously monitoring the goals and objectives while maintaining alignment with the strategic goals and objectives
for UW Health. While the range of duties and responsibilities is broad and varied, the position’s major responsibility is
directing the day-to-day operations, budgeting, financial management, and human resource management. The
Director works closely with a variety of stakeholders, coordinating the activities of Managed Care Contracting across
the enterprise.
The Director is responsible for continued development and maintenance of contractual relationships with health plans
and payers. These payer contracts account for the majority of UW Health revenues and are critical to the financial
health of UW Health. The Director operates with significant autonomy in maintaining and increasing the contracted
business, while negotiating rates that enable UW Health to meet its financial objectives and strategic objectives.. The
Director serves in a leadership role in addressing a wide, complex spectrum of critical management issues, and must
be innovative in developing new partnership structures and reimbursement methods to retain existing contracted
relationships,
• Responsible for the initiation, development, negotiation, and monitoring of contracts on behalf of UW Health. The
Director negotiates directly with VPs, Medical Directors, CEOs, CFOs, attorneys, and other executives from these
external entities and supports staff in their negotiation efforts. Negotiations include discussion on payment rate
and structure, and all aspects of contract language.
• The Director engages with a wide variety of internal and external contracts, as the contracts include providers
beyond just UWHC and UWMF, but also UW Health NIL, UnityPoint Meriter, UW Health Rehabilitation Hospital
and other UW Affiliates.
• Providing UW Health senior management staff insight and knowledge in order to facilitate net revenue budgeting,
long term planning, and the strategic planning of major hospital programs or significant clinical programs. The
Director will interpret and provide decision support information and reports to senior management staff.
• Ensure that the Managed Care team has prioritized and allocated resources for reports and analysis of contract
performance, including standard monthly and periodic reporting as well as adhoc data queries.
• Manage communication to all the various providers and affiliates. Ensure resources and tools are utilized to share
key contract information regarding operational terms, legal requirements and rates with operational and revenue
cycle teams at the various provider entities.
• Coordinating efforts to integrate and align UW Health contracting efforts among newly acquired organizations and
for new partnerships between UW Health and organizations where UW Health will serve as the contracting agent.
The Director of Managed Care Contracting serves as the programmatic and operational leader for Managed Care
Contracting and is responsible to the Vice President, Managed Care Contracting and works closely with UW Health
employees, physicians and leaders.
MAJOR RESPONSIBILITIES
Departmental Leader
• Provides an experience and environment of patient- and family-centered care.
• Interprets impact of broad scope organizational change for staff and develops change strategies for successful
implementation.
• Incorporates UW Health’s vision, missions and values in goals and programs within Managed Care Contracting.
• Develops and manages operational initiatives with measurable outcomes.
• Formulates objectives, goals and strategies collaboratively with other stakeholders.
• Prepares and delivers reports to operational leadership outlining progress toward meeting annual goals and
objectives, to include performance related to finance, clinical activity, quality, safety, marketing, and human
resources.
Financial Manager
UW HEALTH JOB DESCRIPTION
• Actively seeks opportunities to improve financial outcomes, engaging staff in the process.
• Establishes annual financial goals and actively uses benchmarking to high performing systems in similar area of
expertise to set annual targets.
• Monitors and analyzes financial data and utilizes for decisions regarding FTE’s, staffing and operational budget.
• Establishes an annual operating and capital budget, demonstrating fiscal responsibility through meeting budget
targets.
• Creates business plan(s), justifying variances and analyzing cost benefit of programs.
• Directs and provides guidance to managers to effectively allocate resources based on patient volume, space
availability, budget constraints, and program priorities, goals and objectives.
• Articulates to staff the budget and the context within the organizational financials.
Administrative Leader
• Contribute to the success of the UW Health by providing leadership, direction and coordination of operations,
finances and human resources for area of responsibility.
• Manage and direct all activities within area of responsibility.
• Continually assesses all services, identifies problems, utilizes data to analyze and propose innovative approaches
for solutions.
• Maintain records related to operations and services that are complete, accurate, available, and in compliance with
all legal, regulatory, and policy requirements.
• Engages staff and other stakeholders in continuous improvement of systems and processes; manages resources
for staff participation in improvement work activities.
• Ensures effective facilitation of improvement teams and development of leadership skills to ensure overall
effectiveness of the meetings.
• Organizes and prioritizes time and resources to manage efficiency. Appropriately delegates.
• Remains current of new trends and best practices and incorporates into Managed Care Contracting practices and
programs.
• Articulates and enforces standards for quality/safe patient care
• Develops and implements innovative systems and processes that improve staff and patient quality and safety
• Demonstrates achievable and measurable results and develop action plans for improvement
• Initiates, monitors and enforces regulatory requirements
• Holds self and others accountable to policy, standards and commitments and provides timely follow through on
questions and concerns.
• Ensures development of Managed Care initiatives to improve patient satisfaction and family centered care.
• Develops and implements clinical outcome measures for quality improvement, cost and complication reduction, and
the implementation of evidence-based medicine.
• Incorporates the use of evidence based practice and appreciative enquiry into program development and
improvement activities
• Actively listens to staff ideas and concerns, assesses others communication styles and adapts to them.
• Effectively facilitates meetings at Managed Care Contracting Department and organizational level.
• Creates bi-directional systems that effectively communicate information and data, utilizing multiple methods.
• Articulates and presents data, information and ideas in a clear and concise manner.
• Communicates opinions and ideas in a nonthreatening and nonjudgmental manner to staff, peers and others.
• Communicates with physicians, academic department leaders, and senior administrators to maintain coordination
with other UW Health programs.
• Demonstrates empathy and concern while ensuring Managed Care Contracting goals are met.
• Manages the complex interdepartmental and interdisciplinary relationships to assure collaboration and
effective/efficient operations within Managed Care Contracting.
• Creates an environment that encourages diverse opinion, recognizes differences and incorporates into process
and services.
• Exhibits awareness of personal attitudes and beliefs, recognizing its effect on response to others.
• Creates a culture and systems for recognizing and rewarding staff.
UW HEALTH JOB DESCRIPTION
Resource Manager
• Creates and maintains a satisfying workplace that fosters professional growth and job satisfaction for all members
of the healthcare team.
• Interviews to select top talent, matching Managed Care Contracting Department needs with appropriate skill sets.
• Develops and implements recruitment and retention strategies that support a culture of leadership.
• Identifies and addresses own professional growth needs.
• Assesses manager and staff development needs, identifies goals and provides resources.
• Identifies lack of competency in performance and establishes a plan which includes goals, interventions and
measures.
• Maintains membership in professional organization(s) to develop knowledge and resources through networking,
continuing education, and participation in national, regional, and/or local activities.
• Ensures integration of ethical standards and core values into everyday work activities.
Educator/Research Facilitator
• Provides opportunities to aspiring clinicians and leaders to develop skills to meet career goals.
• Contributes to a learning environment by providing educational and research experiences to students, residents,
fellows, and faculty.
Critical Interfaces
• Leads and/or serves on a variety of appropriate internal and external committees to represent the Managed Care
Contracting Department
• Serves as a representative of Managed Care to UW Health in order to facilitate the shared interests and relationship
between the parties.
ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH
PERFORMANCE STANDARDS.
JOB REQUIREMENTS
Education
Bachelor’s degree in a relevant subject area such as Accounting, Business
Administration, Finance, Health Care
Master’s degree in a relevant subject area such as Business Administration or Health
Care Administration
Work Experience
Five (5) years relevant experience in the management of managed care contracting
experience or provider network experience in an insurance or health care setting
Experience in a large academic or complex health program that included Managed
Care experience.
Licenses &
Certifications
Required Skills, Knowledge, and Abilities
• Excellent communication and interpersonal skills to include the ability to
negotiate and resolve conflicts and build teams.
• Demonstrated creativity and flexibility.
• Ability to operate in high-pressure situations.
• Excellent organizational skills.
• Demonstrated innovative approach to problem resolution.
• Ability to work collaboratively across UW Health entities and disciplines.
Demonstrated commitment to patient- and family centered care.
• Broad knowledge of modern health care administration practices and principles
within a managed care environment and/or an academic medical center.
• Effective analytical ability in order to develop and analyze options, recommend
solutions to and solve complex problems and issues.
• Demonstrated effective managerial and administrative leadership of clinical
operations
• Knowledge of principles and techniques used in negotiation as applied to service
contracts and equipment purchasing.
• Effective organizational, planning and project management abilities.
• Experience in financial and programmatic presentations.
UW HEALTH JOB DESCRIPTION
• Ability to function independently and deal with multiple, simultaneous projects.
• Ability to recognize personal strengths and weaknesses and develop goals for
professional growth and achievement.
• Ability to demonstrate a commitment to quality and excellence.
Effective leadership abilities:
• Ability to implement change in a positive, sensitive and forward- thinking manner
• Planning and problem solving
• Developing goals and objectives, and establishing priorities
• Inspires confidence, appropriate risk taking and achievement of high standards
• Self-starter with a willingness to try new ideas
• Positive, can-do attitude coupled with a sense of urgency
• Good judgment and ability to act decisively at the right time
• Ability to persuade others and develop consensus
• Effective communication skills both in written and verbal presentation with a
communication style that is open and foster trust, credibility and understanding.
• Ability to effect collaborative and promote teamwork
• Ability to ensure a high level of customer satisfaction including employees,
patients, visitors, faculty, referring physicians and external stakeholders
• Ability to create win/win solutions and relationships
PHYSICAL REQUIREMENTS
Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable
accommodations may be made available for individuals with disabilities to perform the essential functions of this position.
Physical Demand Level
Occasional
Up to 33% of the time
Frequent
34%-66% of the time
Constant
67%-100% of the time
X
Sedentary: Ability to lift up to 10 pounds
maximum and occasionally lifting and/or
carrying such articles as dockets, ledgers and
small tools. Although a sedentary job is defined
as one, which involves sitting, a certain amount
of walking and standing is often necessary in
carrying out job duties. Jobs are sedentary if
walking and standing are required only
occasionally and other sedentary criteria are
met.
Up to 10#
Negligible
Negligible
Light: Ability to lift up to 20 pounds maximum
with frequent lifting and/or carrying of objects
weighing up to 10 pounds. Even though the
weight lifted may only be a negligible amount, a
job is in this category when it requires walking
or standing to a significant degree.
Up to 20#
Up to 10# or requires
significant walking or
standing, or requires
pushing/pulling of arm/leg
controls
Negligible or constant
push/pull of items of
negligible weight
Medium: Ability to lift up to 50 pounds
maximum with frequent lifting/and or carrying
objects weighing up to 25 pounds.
20-50#
10-25#
Negligible-10#
Heavy: Ability to lift up to 100 pounds
maximum with frequent lifting and/or carrying
objects weighing up to 50 pounds.
50-100#
25-50#
10-20#
Very Heavy: Ability to lift over 100 pounds
with frequent lifting and/or carrying objects
weighing over 50 pounds.
Over 100#
Over 50#
Over 20#
Other - list any other physical
requirements or bona fide occupational
qualifications not indicated above:
•
Work/Environmental: Moderate noise level consistent with an office environment
Note: The purpose of this document is to describe the general nature and level of work performed by personnel so
classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.