Manager, Contracts Managed Care

3 weeks ago

Fountain Valley, United States MemorialCare Medical Foundation Full time

Description

Title: Manager, Contracts Managed Care

Location: Fountain Valley / Pre-dominantly Remote

Department: Contracting

Status: Per Diem

Shift: Day

Pay Range*: $60/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Manager, Contracts Managed Care is responsible for negotiating, reviewing and amending payer contracts. Assume responsibility for contract negotiations under the direct supervision of the VP, Payer Contracting. Analyze impact of contract proposals. Ensure assigned contracts meet financial performance requirements. Provide/distribute payer updates to relevant staff.

Essential Functions and Responsibilities of the Job

Review, negotiate, amend and complete provider contracts Responsible for managing and analyzing proposal through research and comparison of industry rates to determine market competitiveness Review, negotiate, amend and complete IPA payor contracts based on strategic and/or operational initiatives Function as a liaison between Contracting and other internal departments to determine services that need to be contracted and inform/educate of existing contracts Work in conjunction with Medical Management or Utilization Management to facilitate the completion of Letters of Agreement (“LOA”) for non-contracted providers including determining the financial risk and negotiating the terms of the LOA. Assist in marketing, business development or other initiatives.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our for more information about our Benefits and Rewards.

Qualifications

Minimum Requirements

Qualifications/Work Experience:

Minimum of 3 years’ experience negotiating provider contracts in managed care environment in an IPA, Medical Group, Hospital or Health Plan. Experience working with providers, health plans, members and vendors. Must be able to handle a high volume work load and effectively prioritize work to meet changing deadlines. Must have Excellent communication skills, problem solving and analytical skills; ability to interact effectively with providers and with at all levels within the organization

Education/Licensure/Certification:

Highschool Diploma required, Bachelor’s Degree preferred.

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