Contract Manager, Managed Care

Under the supervision of the National Director of Managed Care, the Contract Manager, Managed Care is responsible for the overall coordination of the national managed care department’s daily functions and duties.*Assists Director of Managed Care as in-house department support in the receiving and preparation of multiple managed care contracts, contract renewals, and amendments requiring timely reviews, financial analysis and in-house legal assistance when needed from Company facilities nationally. Will negotiate and renew managed care contracts as requested.*Coordinates and/or completes managed care organization credentialing documents, managed care participation applications and all other approved submission of Company facility documentation to managed care companies as requested.*Assists Director with contract due diligent tasks of perspective and renewal managed care contracts including but not limited to investigating insurance company financial status through the Dept. of Managed Healthcare and other similar governmental insurance monitoring offices, federal agencies and other reputable sources that tracks insurance companies nationally.*Assists Director in the retrieval of necessary managed care contract financial and utilization performance reports by insurance company via Company data base and/or other resources in order to negotiate approved protective contract language and reimbursement methodologies for Company facilities.*Prepares and receives contract documentation packages for Company facilities and Corporate approval. Organizes distribution of contract packages back to required Company facilities and managed care organizations after contract execution.*Coordinates and maintains contract file system of all managed care contracts copies nationally. Prepares and maintains national contract rate matrix with renewal/termination calendar in order to assist facilities in renewal opportunities on a timely basis. Communicates renewal timelines with Company facilities in advance for timely notifications for negotiations for contract renewals or terminations.
*Supports Director in serving as the information resource to the Business Development team regarding managed care contract terms, rates, insurance verifications, and insurance company industry updates with the goal of converting managed care referrals into admissions.
*Assists in providing all necessary managed care admission and continued stay information to CBOs, Admissions, Case Management, Medical Records, etc. in order to assure appropriate contract compliance and reimbursement for managed care members treated at Company facilities.*Coordinates or assists Company Facility’s with non governmental pre admissions, verification of insurance benefits, obtaining insurance or medical group authorization and/or certification and Letters of Agreement as needed. Communicates written and verbal instructions regarding approved admissions to designated Company facilities prior to member admission.*Assists Director in responding to managed care organization’s request for Company informational packets, service inventory updates, copies of current licenses and certificates as they pertain to contract discussions. This would include responding quickly and courteously to payor inquiries via phone, mail or email.*Assists Director in preparing departmental correspondence, memoranda, reports and rates proposals as requested.*Assists Director with any other departmental functions and activities as requested. Assist in the continuance of all of the above in a timely and complete manner during the Director of Managed Care’s participation in off site local and national meetings with insurance companies, physician groups, Corporate and Company facilities, etc
REQUIREMENTS
Mandatory:1.At least ten years experience in a Hospital Managed Care environment within the acute care hospital industry including a strong knowledge base of managed care contract and reimbursement terms, in and out-of-network insurance benefits, all facets of Letter of Agreement development and negotiations, and contract payment methodologies at the local and national level.
2.Strong in contract maintenance and interpretation of contract terms to field staff and Company facility departments nationally.
3.Five years office experience including data tracking, Excel and Power Point presentations, basic legal contract document preparation, distribution, maintenance and storage.Preferred:1.Bachelor Degree in Healthcare Admin, Business, Finance or equivalent.
2.Understanding of acute hospital managed care business development strategies with contracted and non contracted insurance companies, workers compensation organizations, medical groups and capitated hospitals in order to support Company’s managed care census and revenue goals.
3.Hospital health insurance products in a managed care environment.
4.Knowledge of California managed care/healthcare market, applicable state healthcare laws related to managed care with expectations of learning all markets where Company has a presence.