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Job: Manager, Managed Care

This posting has expired and is no longer available.

Job Description

POSITION SUMMARY: 
The Manager, Managed Care will implement strategies to improve managed care net revenue for the market.  The Managers duties will include (but not be limited to); direct administrative, legal, operational and financial issues related to contract/payor negotiations. 
PRIMARY RESPONSIBILITIES: 
  • Renegotiation of physician managed care agreements in accordance with the Contracting Plan developed each fiscal year.
  • Serves as the "point person" to the IASIS hospitals’ business offices with regard to tracking and reducing managed care denials and underpayments, including restitution or other prompt pay penalties.
  • Assists in the interpretation of managed care agreements as it pertains to contract language and reimbursement terms.
  • Assists in the negotiation and renegotiation of managed care and/or other third party payor contracts to achieve operation objectives with results that are in accord with overall market needs and budgeted targets.
  • Carries out appropriate managed care related education and training, including the roll out and implementation of new payor contracts; and assures that new contracts are implemented in a timely and accurate manner.
  • As necessary, completes hospital credentialing and recredentialing applications for managed care organizations with which market hospitals are contracted.
  • Responsible for the distribution of managed care related information to the appropriate departmental directors and managers within the hospitals.
  • Works with various hospital departments to complete managed care and service line analysis to ascertain if specific services are profitable under certain conditions.
  • Participates in weekly, regional revenue cycle teleconference to address existing reimbursement related issues, including but not limited to claim denials, underpayments, and bad debt.
  • Provides managed care resources to physicians, as requested.
  • Coordinates special projects regarding reimbursement and operational issues with managed care payors via monthly or quarterly meetings with the payors.
  • All other duties as assigned.


Qualifications

SKILL OR EXPERIENCE REQUIREMENTS:
  • Minimum requirement of five (5) years’ experience in health care or insurance organizations with experience in contract negotiation/renegotiation, physician interaction, network development, and alternative reimbursement methodologies (i.e., risk arrangements).
 
EDUCATION OR SPECIFIC TRAINING REQUIREMENTS:
  • Bachelor’s Degree preferred
 
ADDITIONAL SKILLS NEEDED:
  • Excellent interpersonal skills with the ability to establish effective communications with internal and external clients.  This shall include oral and written communication skills.
  • Effective leadership and management skills; and project management experience so to ensure projects are completed, timely.
  • Ability to prioritize work with minimal supervision, in order to independently carry out the duties of the position.
 
ADDITIONAL COMMENTS:
  • 0-25% travel required

 

 

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

 
IASIS Healthcare | 117 Seaboard Lane, Building E, Franklin, TN 37067 | p) 615-844-2747 | f) 615-846-3006
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