Contract Mgr. II - health plans

BJC HealthCare • St. Louis, MO

22d • Hybrid

About The Position

BJC HealthCare is seeking a Contracts Manager to assist with healthcare plan negotiations. This role involves managing the negotiation, implementation, and ongoing evaluation of designated managed care arrangements. The goal is to make recommendations and take action to ensure and enhance the success of hospital and physician managed care participation. The Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value-based care and payment programs, payor and provider relations, and direct to employer solutions. This role requires quarterly on-site meetings and therefore the candidate must be located in MO or IL.

Requirements

• Bachelor's Degree
• 5-10 years of experience
• No supervisor experience required

Responsibilities

• Manages Single Case Agreements (SCAs) process for new/innovative services to ensure access for patients and secure reimbursement for the hospital, including problem solving critical issues.
• Responsible for managing the relationship with tier 1 Managed Care Organizations (MCOs), as assigned. This includes facilitating contract negotiations with the MCOs for all components including hospital, physician, ancillary and credentialing agreement in accordance with established guidelines.
• Maintains close partnership with managed care finance and the value based team to ensure agreements reflect accurate rate, language and other provisions.
• Includes redline and replacement of BJC accepted language.
• Independently collaborates with internal stakeholders to ensure strategy is implemented.
• Participate in key internal meetings with HSOs for the purpose of understanding/sharing information that enhances the development and execution of contract strategies.
• Collaborates with BJC Legal to review contract language (redlined language and regulatory attachments) and to identify preferred terms and conditions.
• Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders.
• Educates HSOs on contract provisions and collaborates with Provider Relations in addressing operational issues.

Benefits

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level