Managed Care Manager MHS

Overview

Join to apply for the Managed Care Manager - FT - Days - MHS role at Memorial Healthcare System
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Location:

Hollywood, Florida

Summary:

Corporate level manager responsible for deploying and contributing to strategic and tactical initiatives for negotiations with national and regional payors. Manages execution of contracting initiatives for integrated delivery system to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers. Responsible for securing negotiations of all contractual provisions, implementing appropriate financial reimbursement models, and supporting operations by collaborating with clinical and operational staff to preserve revenue and address payer imposed challenges.

Implement strategic and tactical initiatives to achieve organization and department goals.

• Address all single-case negotiations with non-contracted payors in a timely manner.
• Respond to insurance industry activities, healthcare reform, payer strategies, and changes to the managed care industry to maintain a competitive position.
• Contribute and coordinate negotiations of ancillary services in concert with the Director of Managed Care for large, complex major-payor negotiations.
• Enhance, estimate and preserve net revenues and build market share. Assist with related strategies and operations. Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analysts, contract negotiations and issue resolution. Interface with managed care plans on claim reconciliations, trended issues and operational projects. Determine root cause and seek resolution. Evaluate payor assessments of over payments and effectively dispute or resolve for settlement.
• Execute and manage legal, financial and operational contract language negotiations in concert with the Director of Managed Care. Execute contracting strategies for Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services for fee-for-service and value-based arrangements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements). Monitor and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors.
• Escalate, monitor and manage operational issues from Managed Care Revenue Optimization and Accounts Receivable Management; advise and support optimal operational performance by collaborating with other departments and facility staff impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs, etc. Collect information to resolve issues.

Accountability
, Building a Business Case
, Contracting - Managed Care Payors
, Customer Service
, Financial Counseling - Patient Services
, Healthcare Regulatory Environment
, Leading Change Initiatives
, Managed Care Payor Management
, Managing Business Priorities
, Managing Information
, People Management
, Responding to Change
, Standards of Behavior

Bachelors (Required)

Complexity of Work:
Requires critical and flexible thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a fast paced, high energy environment while multitasking, working independently and delivering quality outcomes. Must have strong technical & financial skills, negotiating skills and knowledge of contract language (develop, draft and interpret) and reimbursement terms. Extensive Managed Care Industry knowledge and understanding of hospital and insurance industries.

Ability to work collaboratively in a collegial environment with multiple stakeholders to achieve department and organization goals. Required

Work Experience:

5 years contracting experience with 3 years contracting for hospital, professional services, ancillary facilities or specialty networks.

• Bending and Stooping = 40%
• Climbing = 20%
• Keyboard Entry = 60%
• Kneeling = 20%
• Lifting/Carrying Patients 35…