Summary The Contracts Manager, Managed Care is responsible for all contracting functions and negotiation of Managed Care contracts with HMOs, PPO's, Medical Groups and State Agencies. These duties require the Contracts Manager to develop priorities, set goals and establish negotiating strategies and to conduct contract negotiations accordingly. Inherent in these duties is conducting the underlying profit/analysis, the reporting of contract performance and the maintenance of contract records. The Contract Manager must also set up procedures for and assure that the managers of hospital departments that are impacted by HMO's, PPO’s, Medical Groups and State Agencies contracts are apprised of the status of negotiations and the impact of such contracts on their operations. The Contract Manager acts as the focal point for questions and education on Managed Care Contracting issues.
This position requires the full understanding and active participation in fulfilling the Mission of Decatur Memorial Hospital; demonstrating behavior consistent with the Core Values; and supporting the strategic plan, goals and direction of the quality improvement, process, and activities.
Essential Functions and Job Duties
Responsible for the development, coordination and analysis of managed care contracts.
Negotiates reimbursement and language of payor contracts.
Addresses operational issues and reviews contracts and terms in order to facilitate implementation.
Responsible for identifying managed care opportunities in the marketplace.
Establishes productive personal relationships with payor reps.
Works closely with Payor Contracting team to ensure timely notification of changes to payors and to ensure all contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely manner.
Manages the planning process for contract renewals and negotiations including assessment of historical performance and issues as well as identification of payor specific issues.
Collaborates with Business Office staff to ensure proper payment/reimbursement and pre-authorization and denial management processes are in place.
Education and/or Other Requirements
Bachelors Degree in Business or a related field; and
Minimum three (3) years experience in contracting, finance, or operations in a health care setting.
Knowledge, through training or experience of Managed (Health) Care or the Managed Care Market is preferred.
Additional Salary Information: Compensated based on experience.