Managed Care Contract Specialist

4 days ago


Toledo, Ohio, United States ProMedica Health System Full time
Job Title: Managed Care Contract Specialist

ProMedica Health System is seeking a highly skilled Managed Care Contract Specialist to join our team. As a key member of our Managed Care team, you will be responsible for developing and implementing managed care strategies and relationships designed to maintain and grow our network of hospitals, primary care and specialty providers, and a clinically integrated network.

Key Responsibilities:
  • Operate as team lead responsible for all behavioral health and vision agreements and managing the relationships with those managed care payors and behavioral health agencies.
  • Manage payer issues that are escalated to Managed Care and ensure each is resolved in a timely and appropriate manner.
  • Lead interdisciplinary team of key stakeholders involved in analyzing relevant data to identify industry changes and policies made to managed care contracts and reimbursement.
  • Negotiate and manage administration of all value-based agreements.
Requirements:
  • Graduate of an accredited college or university in Health Care Administration, Business, Finance or similar field.
  • Experience negotiating managed care contracts in a health system, consulting firm, or with a managed care payor preferred.
  • Knowledge of Ohio and Michigan insurance payors required.
  • Knowledge of basic Microsoft Office tools required.
Preferred Qualifications:
  • Master's degree.
  • Understanding of PHS information systems preferred.
  • Advanced knowledge of Microsoft Office tools.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. We are an equal opportunity employer and welcome applications from diverse candidates. If you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact us.



  • Toledo, Ohio, United States Care Seniors Full time

    About the RoleWe are seeking compassionate and experienced caregivers to join our team at Care Seniors, LLC. As a Companion Care Specialist, you will play a vital role in providing high-quality care and support to our clients, enabling them to maintain their independence and quality of life.Key ResponsibilitiesProvide personalized care and support to clients...


  • Toledo, Ohio, United States The Toledo Clinic Full time

    Job Summary:The Purchasing and Contract Manager will oversee the operations of the Purchasing Department at The Toledo Clinic. This role ensures that all purchases are approved at the appropriate levels and that all contracts meet TTC terms and conditions.Key Responsibilities:Act as liaison between clinical and administrative departments to ensure cost...

  • Psychiatric Nurse

    4 weeks ago


    Toledo, Ohio, United States Supplemental Health Care Full time

    Job Title: Psychiatric Nurse - Travel ContractSupplemental Health Care is seeking a skilled Psychiatric Nurse to join our team for a travel contract position. As a Psychiatric Nurse, you will provide high-quality care to patients with mental illness or addiction, identifying risk factors and educating or intervening as necessary.Contract Details:12 years of...

  • Cleaning Specialist

    3 weeks ago


    Toledo, Ohio, United States Clean Care Full time

    Job SummaryWe are seeking a reliable and detail-oriented Cleaning Specialist to join our team at Clean Care. As a Cleaning Specialist, you will be responsible for maintaining a clean and safe environment for our clients and staff.Key Responsibilities:Perform basic cleaning tasks, including dusting, mopping, and vacuuming.Clean bathrooms, locker rooms, and...

  • Psychiatric Nurse

    4 weeks ago


    Toledo, Ohio, United States Supplemental Health Care Full time

    Job Title: Psychiatric Nurse - Travel ContractSupplemental Health Care is seeking a skilled Psychiatric Nurse to join our team for a travel contract position in Toledo, Ohio.Job Summary:We are looking for a dedicated and compassionate Psychiatric Nurse to provide high-quality patient care in a fast-paced corrections facility. As a travel Psychiatric Nurse,...


  • Toledo, Ohio, United States OneStaff Medical Full time

    Job Opportunity:We are seeking a skilled Medical Care Specialist to join our team at OneStaff Medical. As a Medical Care Specialist, you will be responsible for assisting patients with medical problems related to the blood vessels, heart, and lungs. This includes interviewing and examining patients with breathing or cardiopulmonary disorders, as well as...


  • Toledo, Ohio, United States Lightyear Health Full time

    Job Opportunity at Lightyear HealthJob Title: Clinical Care SpecialistJob Summary:Lightyear Health is seeking a skilled Clinical Care Specialist to join our team. As a key member of our Physical Medicine & Rehabilitation (PM&R) team, you will play a vital role in delivering high-quality care to our patients.Key Responsibilities:Conduct in-person visits with...


  • Toledo, Ohio, United States Abode Care Partners Full time

    About the RoleWe are seeking a compassionate and skilled Nurse Practitioner to join our team at Abode Care Partners. As a leading provider of integrated medical services, we care for individuals from post-hospitalization to home in various settings.ResponsibilitiesProvide evidence-based medical care by planning, directing, and evaluating patient medical...


  • Toledo, Ohio, United States LHH Full time

    Job Title: Accounting SpecialistLocation: City of Industry, CAJob Type: Contract, 3-6 monthsPay: $23-27/hour, based on experienceAbout the Role:We are seeking an experienced Accounting Specialist to join our team at LHH Recruitment Solution. As an Accounting Specialist, you will be responsible for assisting with AP/AR responsibilities, including 3-way...

  • Contract Analyst

    4 days ago


    Toledo, Ohio, United States APS Medical Full time

    APS Medical Billing is seeking an experienced Contract Analyst to join our team in Toledo, Ohio. As a leading billing company, we have grown significantly since our inception in 1960 and now bill for over 250 client locations across the United States. **Responsibilities:**• Catch underpayments and follow up with carriers to retrieve payments• Request...


  • Toledo, Ohio, United States InsideHigherEd Full time

    Job Title: Case Manager, Behavioral SpecialistJoin our team as a Case Manager, Behavioral Specialist and play a vital role in supporting students' academic success and well-being. As a key member of our Behavioral Health Services team, you will provide case management services, including assessment, support, and linkage to resources, to help students...

  • Payor Specialist

    3 weeks ago


    Toledo, Ohio, United States ProMedica Full time

    Job Title: Payor SpecialistThe Payor Specialist is a key member of the Utilization Management team at ProMedica, responsible for ensuring seamless communication with payors to secure authorizations for patient admissions.Key Responsibilities:Perform timely initial notification of all inpatient and observation admissions systemwide with per payor contract via...


  • Toledo, Ohio, United States Innovative Management Systems Incorporated Full time

    Job Title: Claims Examiner II/IIIInnovative Management Systems Incorporated is seeking a highly skilled Claims Examiner II/III to join our team. As a Claims Examiner II/III, you will be responsible for accurately reviewing, researching, and analyzing professional claims for a managed service organization (MSO).Key Responsibilities:Identify authorizations and...


  • Toledo, Ohio, United States Concentra Full time

    Physiatrist / Physical Medicine and Rehabilitation SpecialistPlease note that the salary rate/range mentioned below was provided by Indeed. Concentra's market-specific rate/range will be discussed during the interview process.Concentra, a leading healthcare company, is seeking a Physiatrist/Physical Medicine and Rehabilitation Specialist to join our team as...


  • Toledo, Ohio, United States Yellowstone Landscape Group Full time

    Client Care SpecialistAre you passionate about delivering exceptional client service and building strong relationships with customers? We are seeking a Client Care Specialist to join our team at Yellowstone Landscape Group.About the Role:As a Client Care Specialist, you will be responsible for communicating effectively with customers and our maintenance...


  • Toledo, Ohio, United States Crimson Enterprises Full time

    Join Crimson Enterprises in our search for a skilled Specialist in Internal Medicine to lead our endocrinology practice in the Remscheid area. As a key member of our team, you will be responsible for providing high-quality patient care and contributing to the development of our practice. We offer a permanent contract with attractive compensation and a...


  • Toledo, Ohio, United States Beauty Industry Full time

    Job Title: Procurement SpecialistBeauty Industry is seeking a skilled Procurement Specialist to join our team. As a Procurement Specialist, you will be responsible for managing the procurement process, ensuring timely and cost-effective delivery of goods and services.Key Responsibilities:Order Placement & Tracking: Maintain accuracy within the ERP system,...

  • Accounting Specialist

    4 weeks ago


    Toledo, Ohio, United States LHH Full time

    Accounting Specialist Job DescriptionJob Title: Accounting SpecialistLocation: City of Industry, CAJob Type: Contract, 3-6 monthsPay: $23-27/hour, based on experienceAbout the Job:We are seeking an experienced Accounting Specialist to join our team at LHH Recruitment Solution. As an Accounting Specialist, you will be responsible for assisting with AP/AR...

  • Adult Care Specialist

    3 weeks ago


    Toledo, Ohio, United States Concord Care Center of Toledo Full time

    Job Title: Adult Home CareAt Concord Care Center of Toledo, we are seeking a dedicated and compassionate Registered Nurse (RN) to join our team as a Unit Manager (UM). As a key member of our leadership team, you will be responsible for providing clinical services to our residents and ensuring a safe and risk-free environment.Responsibilities:Provide...


  • Toledo, Ohio, United States ProMedica Toledo Hospital Full time

    ProMedica Toledo Hospital is seeking a skilled RN to fill a contract position in Case Management. The ideal candidate will possess a current state license as a RN and have at least 2 years of recent experience as a Case Management RN. This is a 7a-3p position in the Care Navigation - Ac department. The RN will work closely with the healthcare team to provide...