Manager - Managed Care Contracting

Overview

Job Summary

Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract language and rates for minor payors, or major payors when the scope of the negotiation is limited. Negotiate payor agreements with Director/AVP support. Monitor contract performance versus expected, and recommend any action needed.

Essential Functions

• Assist in the development and implementation of strategies and objectives related to managed care contracting for assigned Managed Care Organizations.
• Responsible for rate and language negotiation of assigned minor payor agreements. Support Director/AVP support for rate and language negotiations of major payor agreements. Assist with the development of negotiation strategy for major payors. Negotiate rate and language of small to mid-size payor agreements.
• Monitor, regularly review and report financial and operational performance of assigned payor contracts versus expectations. Recommend any action needed as a result of contract performance.
• Understand and identify current risks and sources of exposure Primary Enterprise.
• Gather and analyze data and apply methodologies. Draw preliminary conclusions and project application(s). Identify cross-application of data or analysis, directing efforts of other associates, as needed.
• Maintain current detailed working knowledge of all assigned payor contracts and manage System relationship with such payors.
• Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships.
• Provide System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives.
• Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address hospital CFO needs for information resulting from new or modified agreements.
• Develop and maintain cooperative internal working relationships with all parts of the Total Enterprise to effectively evaluate and assess overall impact of contracting initiatives. Serve as MHR Contracting point person for assigned entities.
• Proactively work with Managed Care Analytics to report and refine reporting of contract performance, analysis and modeling tools.
• Work closely with Managed Care Specialist and Managed Care Senior Specialist on operational issues that become contract issues. This includes attendance at payor Joint Operating Committee (JOC) meetings.

Physical Requirements

Perform most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.

Education, Experience and Certifications

Bachelor's degree required, Master's degree preferred (MBA or MHA preferred). Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Bachelor's degree. -OR- Minimum of 2 years experience as a contract negotiator with a large provider or 4 years small provider or payor experience as a contract negotiator with a Master's degree.