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Managed Care Operations Supervisor
2 months ago
Position Summary
This role, reporting to the Operations Director and Executive Director, focuses on the negotiation, enhancement, and management of managed care agreements, including Medi-Cal, Medicare, Commercial, PPO, and FFS.
Work Schedule:
· Flexible hours, with potential evening and weekend commitments.
- Weekly hours may exceed 40.
Key Responsibilities
- Leads negotiations for managed care agreements, ensuring optimal capitation rates and fee-for-service reimbursements.
- Reviews and renegotiates payer contracts, focusing on rates and contractual terms.
- Maintains a comprehensive library of payer contract documentation, including summaries and fully-executed agreements.
- Establishes and nurtures long-term relationships with key payer representatives.
- Collaborates with various departments to produce data analyses that support negotiation efforts.
- Works with divisional managers to promote operational efficiencies and effective contract administration.
- Coordinates with internal teams to ensure timely submission of required documentation to health plans or IPAs.
- Ensures the capture of incentives based on service delivery, including health assessments and timely data submissions.
- Negotiates agreements with IPAs and health plans for specialty services based on fee-for-service models and healthcare outcomes.
- Analyzes productivity and financial reports, providing recommendations and corrective action plans.
- Assists in developing the IPA Network in collaboration with community clinics.
- Partners with leadership to ensure compliance with health plans, IPAs, and regulatory standards.
- Participates in organizational meetings as needed.
- Performs additional duties as assigned.
Minimum Qualifications
- Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook).
- Excellent interpersonal and communication abilities.
- Capable of engaging with all management levels.
- Strong prioritization, multitasking, and follow-up skills.
- Detail-oriented with a commitment to teamwork and independent work.
- Reliable transportation is required, with travel between facilities expected.
- This position involves 10% travel, including frequent trips outside the local area.
Education and Experience Requirements
- In-depth knowledge of Managed Care and IPA business models.
- A minimum of 5 years of experience in Managed Care with a focus on contract negotiations.
- A Bachelor's Degree in Finance, Business Administration, Public Health, or a related field is preferred, or equivalent work experience.
- Strong background in Accounting and Finance.
- Familiarity with Medi-Cal Managed Care, Medicare compliance, and HMO regulatory guidelines.
- Alignment with the mission and values of Northeast Community Clinic.
- Valid State Identification is required.
