Senior Manager, Managed Care
This position is responsible for negotiating reimbursement rates, legal terms, performance programs, and risk arrangements with managed care health plans on behalf of Steward Health Care System, LLC (including Steward hospitals, physicians, and ancillary providers) under the general direction of the Regional VP. Other key responsibilities include assisting with ongoing contract management including contract analysis, database maintenance, and ad hoc projects.
- Negotiate hospital and physician managed care agreements for the Texas and Arkansas markets
- Perform contract analytics and risk analysis to support leadership decisions about managed care contracting
- Design models and perform analysis for the purpose of understanding the historical and future performance of existing contracts; work with Finance and Revenue Integrity team on models and calculations as necessary
- Create and communicate contract finance and risk terms with internal and external leadership including high-level hospital administrators and physician leaders
- Understand, interpret, and summarize provisions and obligations contained in Steward’s managed care contracts
- Redline agreements to support Steward’s overall goals and objectives
- Load payer contracts, rate sheets, fee schedules and other documents into the managed care database
- Coordinate with Revenue Integrity to ensure timely and accurate contract implementation
- Assist in the development of annual budgets and strategic plans
- Prepare regular internal Management Reports as requested, including the Contract Dashboard, Contract Summary Grid and the A/R Tracking Grid
- Maintain constructive, professional relationships with internal and external stakeholders
- Work closely with the Steward hospitals and physician groups to identify system issues (e.g. claims, underpayments, denials) and develop resolutions that can be addressed in the contract negotiations.
- Monitor, interpret, and report on changes in performance, market trends, health care delivery systems and legislative initiatives that impact managed care efforts (e.g. CMS, ACO regulations, Health Reform, etc. ).
- Assist the Vice President and Senior Vice President with other projects as requested
- All other duties as assigned
- Bachelor's Degree required; Master's degree strongly preferred
- Five to Seven years working in a managed care environment in a similar capacity
- Microsoft Office proficiency required (Word, Excel, and Powerpoint), advanced abilities in Excel strongly preferred.
- Understanding of health care delivery setting.
- Experience in the Texas/Arkansas market a plus.
- Analytical skills to collect information from diverse sources and summarize the information and data in order to solve problems
- Accuracy and attention to detail is critical
- Strong interpersonal skills and ability to interact positively with a wide range of constituents
- Proven excellent written and verbal communication skills
- Ability to present information to small, and at times, large audiences
- Strong organizational and project management skills to ensure projects are completed timely and accurately
- Ability to work in a fast paced, evolving organization
- Must be able to maintain confidentiality of information
- Ability to work both independently and within a team environment
- Ability to travel for health plan meetings and internal Managed Care team meetings as needed
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Job Reference #: 1805587