Managed Health Contract Manager

American Addiction Centers • Rome, GA

1d • $36 - $53

About The Position

Assist in the development and implementation of strategies and objectives related to managed care contracting for assigned Managed Care Organizations. Responsible for rate and language negotiation of assigned minor payor agreements. Support Director/AVP support for rate and language negotiations of major payor agreements. Assist with the development of negotiation strategy for major payors. Negotiate rate and language of small to mid-size payor agreements. Monitor, regularly review and report financial and operational performance of assigned payor contracts versus expectations. Recommend any action needed as a result of contract performance. Understand and identify current risks and sources of exposure Primary Enterprise. Gather and analyze data and apply methodologies. Draw preliminary conclusions and project application(s). Identify cross-application of data or analysis, directing efforts of other associates, as needed. Maintain current detailed working knowledge of all assigned payor contracts and manage System relationship with such payors. Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships. Provide System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives. Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address hospital CFO needs for information resulting from new or modified agreements. Develop and maintain cooperative internal working relationships with all parts of the Total Enterprise to effectively evaluate and assess overall impact of contracting initiatives. Serve as MHR Contracting point person for assigned entities. Proactively work with Managed Care Analytics to report and refine reporting of contract performance, analysis and modeling tools. Work closely with Managed Care Specialist and Managed Care Senior Specialist on operational issues that become contract issues. This includes attendance at payor Joint Operating Committee (JOC) meetings. Physical Requirements Perform most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds. Education, Experience and Certifications. Bachelor's degree required, Master's degree preferred (MBA or MHA preferred).Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Bachelor's degree. -OR- Minimum of 2 years experience as a contract negotiator with a large provider or 4 years small provider or payor experience as a contract negotiator with a Master's degree. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care

Requirements

• Bachelor's degree required, Master's degree preferred (MBA or MHA preferred).
• Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Bachelor's degree.
• OR- Minimum of 2 years experience as a contract negotiator with a large provider or 4 years small provider or payor experience as a contract negotiator with a Master's degree.

Responsibilities

• Assist in the development and implementation of strategies and objectives related to managed care contracting for assigned Managed Care Organizations.
• Responsible for rate and language negotiation of assigned minor payor agreements.
• Support Director/AVP support for rate and language negotiations of major payor agreements.
• Assist with the development of negotiation strategy for major payors.
• Negotiate rate and language of small to mid-size payor agreements.
• Monitor, regularly review and report financial and operational performance of assigned payor contracts versus expectations.
• Recommend any action needed as a result of contract performance.
• Understand and identify current risks and sources of exposure Primary Enterprise.
• Gather and analyze data and apply methodologies.
• Draw preliminary conclusions and project application(s).
• Identify cross-application of data or analysis, directing efforts of other associates, as needed.
• Maintain current detailed working knowledge of all assigned payor contracts and manage System relationship with such payors.
• Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships.
• Provide System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives.
• Provide education on new agreements as they affect stakeholders via written communications or presentations as needed.
• Anticipate and address hospital CFO needs for information resulting from new or modified agreements.
• Develop and maintain cooperative internal working relationships with all parts of the Total Enterprise to effectively evaluate and assess overall impact of contracting initiatives.
• Serve as MHR Contracting point person for assigned entities.
• Proactively work with Managed Care Analytics to report and refine reporting of contract performance, analysis and modeling tools.
• Work closely with Managed Care Specialist and Managed Care Senior Specialist on operational issues that become contract issues.
• This includes attendance at payor Joint Operating Committee (JOC) meetings.

Benefits

• Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
• Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance
• Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program

What This Job Offers

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