USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.
SUMMARY
As a Government Payer Program Manager at U.S. Renal Care, you will lead projects from start to finish across various business units. Responsibilities include managing project deliverables to support government payer relations by utilizing internal teams, resources, developing plans, facilitating stakeholder communication, assessing risk management, and ensuring quality deliverables. The ideal candidate should demonstrate proficiency in tailoring best practices, overseeing multiple initiatives simultaneously, and partnering closely with cross functional internal stakeholders, including Executive leadership and external partners. Direct oversight of payer relations with governmental agencies and third-party payers, such as Veterans Affairs, Medicare, State Medicaid, Medicare Advantage, Managed Medicaid and Tricare. Successful candidates must be analytical, solution-oriented, flexible, and engage positively with stakeholders. At U.S. Renal Care, your work has purpose, colleagues care about your well-being, and you have the opportunity to grow and thrive.
Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.
- Serve as the primary manager with responsibility of government payer programming. Develop, implement, and manage to contracting requirements with all stakeholders.
- Oversee assigned government projects to ensure alignment of strategic objectives and action plans, achievement of deliverables and KPIs, and sustained compliance across all aligned internal departments.
- Define KPIs, track performance metrics, and implement strategies to meet financial goals and contractual obligations; while identifying growth opportunities, risks, and performance gaps.
- Develop and execute detailed project plans, including scope, timelines, budgets, and risk strategies; communicating status to Leadership and project stakeholders.
- Facilitate regular internal and external meetings, including Steering Committee meetings
- Ensure adherence to government regulations, including federal, state, and local laws, and preparing for internal communication of changes or impacts to regulations and reimbursement.
- Proactively monitor CMS and Medicaid regulations, policies, and pricing changes to evaluate their impact on reimbursement methodologies, contractual commitments, and operational requirements.
- Support provider networks and align government payer-provider strategies to improve care delivery.
- Ability to manage multiple concurrent projects from concept to completion using agile mindset and methodologies; accountable to drive velocity and quality in delivery.
- Proactively identify and track issues and dependencies; partner with teams to develop mitigation strategies
- Effectively communicate expectations; accepts accountability and holds others accountable for performance.
- Participates in team concepts and promotes team efforts; performs duties in accordance with company policies and procedures.
- Meet project deadlines as required by payer programs and leadership.
- Ability to work autonomously and independently within the position and responsibilities.
Qualifications/Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
Requirements include:
- Bachelor's degree required in Business, Healthcare Administration, or other related disciplines. Masters degree preferred.
- Ten plus (10+) years experience with Government strategy/contracting, project management or operations; other relevant experience will be considered; previous dialysis experience a strong plus.
- Comprehensive understanding of CMS and Veterans Affairs pricing frameworks, policy directives, regulations, and their operational implications across reimbursement and compliance.
- Must possess working knowledge of contractual, administrative, health insurance and operational issues related to Managed Care Organizations, and health insurance benefit plan designs.
- Strong ability to interpret and make decisions from data; ability to predict and request necessary data for decision making; intermediate or advanced analytical skills (Excel, Access, other data management or data modeling) a strong plus but not required.
- Proficient with all Microsoft Office products, including Outlook, Team, and Word.
All Full Time employees are eligible for the following benefits: Medical / Pharmacy Dental Vision Voluntary benefits 401k with employer match Virtual Care Life Insurance Voluntary Benefits PTO All Part Time employees are eligible for the following benefits: 401k with employer match PTO
