CSI Director of Managed Care

April 7

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CSI Pharmacy

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CSI Pharmacy is a nationwide specialty pharmacy that focuses on providing services and therapies for patients with chronic and rare illnesses requiring complex care. Founded by pharmacists, the company is dedicated to improving the health and lives of its patients by offering individualized infusion therapies, specialized pharmaceutical knowledge, and passionate patient advocacy. With a presence across the country, CSI Pharmacy offers services such as nursing, pharmacy services, insurance and reimbursement navigation, and patient advocacy, aiming to treat each patient with personalized attention. The company specializes in treating rare diseases with biologics and plasma-derived therapies and is committed to optimizing patient outcomes in the comfort of their homes.

IVIG and SCIG • specialty pharmacy • home infusion • patient advocacy • rare disease therapy

51 - 200 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧬 Biotechnology

📋 Description

• Leads the implementation process of managed care contracts and develops and maintain systems to disseminate contract information • Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle • Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payors and providers • Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations • Responsible for coordination and communication between managed care and other interested party departments and leadership • Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations • Oversight of payer credentialing • Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting • Communicates with respective payers related to trends and compliance with contract parameters • Consistently represents the company in a professional manner • Maintain effective working relationship and cooperate with all personnel in the Company • Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies • Perform other duties and responsibilities as assigned

🎯 Requirements

• Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contracts • Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possible • Must possess the ability to multi-task and frequently change direction