Managed Care Contracting Manager

2 weeks ago

Atlanta, United States Core Clinical Management LLC Full time
Job DescriptionJob DescriptionDescription:

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.


The Managed Care Contracting Manager is responsible for negotiating contracts between healthcare providers and managed care organizations (insurance companies or health maintenance organizations). This role involves analyzing market trends, evaluating reimbursement rates, and ensuring that contracts meet regulatory requirements. This role is crucial in ensuring that our organization maintains financially sustainable relationships with managed care entities while delivering quality healthcare services to patients.


Essential Duties:

  • Analyze data related to healthcare utilization, costs, current reimbursement, and outcomes to information contract negotiations and decision-making.
  • Lead negotiations with managed care organizations to secure favorable terms for healthcare services provided by our organization.
  • Assess the financial implications of proposed contracts, including reimbursement rates, fee schedules, and payment terms.
  • Ensure that contracts comply with legal and regulatory requirements, as well as internal policies and procedures.
  • Lead the Independent Dispute Resolution (“IDR”) process
  • Build and maintain strong relationships with managed care organizations, healthcare providers, and internal stakeholders.
  • Develop and implement strategies to optimize reimbursement and improve financial performance through manager care contracts.
  • Review existing contracts, identify areas for improvement or renegotiation, and implement changes as needed for an in or out of network strategy.
  • Propose edits in the contract language to arrive at the most favorable contract terms for our organization.
  • Develop contract reporting and repository to easily identify current state of in- network and out of network status with managed care entities.
  • Maintain a strict level of confidentiality for all company, departmental, and healthcare provider information.
  • Perform other related duties as assigned.



Skills, Knowledge, Abilities:

  • Excellent negotiation skills.
  • Strong organizational skills with the ability to multi-task in a fast-paced environment.
  • Ability to adapt, modify and prioritize while adhering to strict deadlines and a willingness to shift priorities to meet the needs of the organization.
  • Excellent communication and interpersonal skills and demonstrated ability to interact with a variety of team members.
  • Self-motivated with the ability to identify opportunities for improvement and demonstrate the initiative to resolve issues in support of improvement efforts.
  • Strong analytical skills and the ability to work independently to analyze and solve problems.
  • Sharp attention to detail when reviewing proposed contracts from managed care entities.
  • Navigate competing priorities and effectively work in a fast-paced environment.
  • Proficient in Microsoft Office Site and Adobe.
  • Exhibit growth mindset and team-orientated behaviors.
  • Collaborate with professionals internal and external to the company and across geographic locations.





Requirements:

Education:

  • Bachelor’s degree in Healthcare Administration, Business Administration, or related field is preferred.


Experience:

  • At least five (5) years of experience in Managed Care or Healthcare Administration
  • Emergency/Hospital Medicine experience preferred but not required


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