COME JOIN AN EXCITING AND INNOVATIVE COMPANY THAT PUTS THE “CARE” BACK IN HEALTHCARE!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

ABOUT US:

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.

SUMMARY:

This position is responsible for operational oversight and execution of managed care strategy and initiatives, including contract implementation, payer relations support, contract performance, new drugs to market, formulary alerts and cross-functional coordination. This role ensures that managed care initiatives are aligned with organizational goals, fiscal contract performance, and enhance patient access and satisfaction.

SKILLS AND ABILITIES:

• Excellent analytical, verbal, written and negotiation skills.
• New drug to market product launch and contract implementation
• Familiarity with contract mechanics, language review and pricing analyses.
• Collaboration in development of payer-provider partnership strategies.
• Strong organizational and problem-solving skills.
• Ability to thrive in a fast-paced, dynamic healthcare environment.
• Skilled at interdepartmental communication and training.

EDUCATION AND/OR EXPERIENCE:

• Bachelor’s degree in healthcare administration, Business, Finance, -or- equivalent related industry experience.
• Minimum of 3 years of experience in managed care operations, encompassing payer relationship development, implementation and payer policy review.
• Strong understanding of managed care contracting, reimbursement methodology, intake/authorization processes, payer formulary watch and healthcare policy/regulation.
• Proven ability to lead cross-functional initiatives and manage multiple, complex projects.
• Experience with overall managed care operational processes development, training and orientation.
• Proficiency in data analysis tools and related healthcare information systems.

1. Lead the operational execution of managed care contracts, ensuring compliance with terms, policies and optimizing performance.
2. Collaborate with finance, revenue cycle, clinical operations, and legal teams to facilitate outreach to escalated payer operations.
3. Monitor payer performance, identify trends, and develop action plans to address underperformance or operational issues.
4. Oversee the development and maintenance of dashboards and reporting tools to track key performance indicators (KPIs).
5. Serve as a liaison between the organization and payers to resolve operational issues and foster strong working relationships.
6. Drive initiatives to streamline processes, reduce administrative burden, and improve reimbursement accuracy.
7. Ensure timely and accurate communication of contract terms and updates to internal stakeholders.
8. Support program initiatives, including Site of Care Redirection, Preferred Provider relationships, quality metrics and population health strategies.
9. Lead, mentor, and develop a high-performing managed care operations team.
10. Other related duties as assigned by manager or designee.