Manager of Managed Care

4 weeks ago

Clearwater, United States CareerBuilder Full time

The Manager of Managed Care:
Monitor state and federal contract requirements and work with internal and external business partners to achieve 100% compliance.
Collaborate with leadership, identify appropriate contracting and re-contracting opportunities and initiate discussions with key constituents.
Create and maintain high level contacts with existing and potential contracting partners.
Collaborate with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensure contracting efforts remain aligned with program goals.
For new relationships or service lines, perform business and market analysis to determine viability of contracting.
Lead contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Lead development of rate and language proposals. Collaborate with internal staff on modeling of rate proposals. Ensure contract terms can be administered and monitored in a cost-effective manner. Effectively interface with management, finance, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
Manage all aspects of the contract life cycle. Collaborate to assemble and gain an understanding of payer specific data, operational issues, and business review. Implement execute contracts, communicate contract changes internally, maintain appropriate documentation, review contract performance reports and makes appropriate recommendations.
Facilitate problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identify and communicate opportunities for process improvement with managed care organizations and internal stakeholders.
Coordinate with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serve as the expert on all terms of the payer contract for both internal and external parties.
Participate in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies.
Stay abreast of the changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Lead discussions pertinent to contract performance, market changes, market intelligence, and strategic decision-making.
Position Qualifications/Requirements:
Education and/or Experience :

Bachelors degree (B.A.) from four-year college or university in healthcare or business preferred; or two to four years related experience and/or training; or equivalent combination of education and experience.
Strong interpersonal skills and attention to detail
At least four years of prior experience in a hospital, provider, or managed care setting.
Technical proficiency in Microsoft Office Applications
Ability to analyze information and convert to related work plan.
Employee must sign a Business Protection Agreement.
Empath Health values diversity as it strengthens our community and care. We embrace the diversity of cultures, thoughts, beliefs and traditions of our employees, volunteers and people we are honored to serve across our network. Our diverse staff reflects our community and each day, we work to be respectful, sensitive and competent with each other and those in our care. In every journey, we are dedicated to achieving comfort, dignity and exceptional care. Those of all backgrounds are welcome and encouraged to apply with us or seek our care and services.
Our commitment to patient, client, staff and volunteer safety is a cornerstone of a High Reliability Organization with a focus on zero harm. Participation in the seasonal influenza is a condition of employment and a requirement for all Empath Health employees.
Providing compassionate, full life care is an honor we take seriously at Empath Health. Join our team and make a positive impact in the community

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