The Contract Manager assists in the negotiation, analysis, and implementation of moderate to complex health plan agreements, physician contracts including call coverage and medical directorships, LOAs and other managed care arrangements to meet financial objectives of MemorialCare. This position assists leaders in the department with health plan negotiations as well as important projects and various responsibilities associated with managed care, key service lines and physicians. The Contract Manager represents the department at meetings, such as BDTs and JOCs and acts as a liaison between PFS and our contracted entities. The Executive Director is supported by the Contract Manager in the completion of tasks and project management within the designated timelines. This position assists in the development and implementation of department strategies and initiatives. Other responsibilities include interaction with health plan counterparts and physicians to promote alignment, assistance in ASC contracting, review of health plan policies and interpretation issues related to managed care contracts. Principal Duties and Responsibilities:
Assists in the negotiation of health plan agreements for hospital and ASCs within the required timeline while achieving financial objective
Assists department leaders with complex projects, task management, and department goals
Works with Business Office in resolving payment and interpretation issues related to Managed Care agreements
Assists hospital leaders on projects promoting physician alignment and key service line growth
Participates on internal teams to provide Managed Care expertise and education.
Works with the Financial Analysis staff to provide specific contract information needed to understand the impact of contract proposals and interpretation of margin analysis.
Assists Decision Support in researching and understanding medical policy and new technology coverage and reimbursement
Negotiates and manages affiliated ASC health plan agreements
Assists in the management and negotiation of affiliated medical group ancillary and operating agreements.
Work Experience:
Minimum three years managed care experience including ability to negotiate, analyze and implement managed care contracts.
Strong problem resolutions skills, ability to delegate and complete multiple tasks in a timely and efficient manner.
Solid presentation and communication skills, excellent interpersonal and organizational skills and ability to work independently with minimal supervision.
Education:
B.S Degree preferred or minimum five years’ relevant experience in managed care.
