Manager of Managed Care Operations

Keystone Advisors LLC•Chicago, IL

About The Position

Keystone Advisors is looking for a Manager of Managed Care Operations to support one of our healthcare clients in the Illinois Medical District in the West Loop of Chicago. Job Summary: The Manager of Managed Care Operations works collaboratively with staff at managed care plans as well as internal hospital departments, such as Revenue Cycle, Finance, and Data Analytics to implement managed care strategies that maximize the financial success of managed care contracts. The Manager of Managed Care Operations will be responsible for assisting the Director with contract negotiations and ensuring that requirements and initiatives are successfully executed resulting in improved access to contracted services, improved outcomes, and increased profitability.

Requirements

Must understand healthcare contracting including financial analysis, credentialing, legal review, Value Based Care, and utilization data.
Effective communication skills both written and verbal as well as the ability to exercise judgement when working with individuals with different points of view on a critical issue.
Excellent presentation and negotiation skills
Ability to maintain confidentiality of all patient information, per HIPAA requirements.
Knowledge and high level of proficiency in Microsoft Office software suite.
Strong interpersonal and leadership skills to lead and direct the Managed Care department.
Bachelor’s degree from an accredited university.
Five (5) years of managed care work experience within a health system, managed care organization, or consulting firm.
Strong leadership and negotiation skills. Knowledge of managed care contracting rates for network providers, services, and facilities.
Advanced ability to operate computers and related software for Microsoft programs including Word, Excel, Outlook.
Sound financial acumen and the ability to analyze and interpret financial reports and metrics.
Proven ability to build and maintain strong relationships with vendors and internal stakeholders.

Nice To Haves

Master’s degree in business administration, health administration or finance from an accredited college or university.

Responsibilities

Assists the Managed Care Director with negotiations, for both fees for service & value-based care agreements through the use of financial analysis and contract language reviews.
Maintains relationships with Payers and works to resolve contract compliance issues by working closely with revenue cycle leadership, to ensure revenue streams are not disrupted.
Assists the Managed Care Director with the oversight of contracted managed payers.
Develop and oversee the implementation of strategies to improve managed careperformance in terms of utilization, patient access, cost, compliance with contractual quality measures, etc. Align improvement with quality and financial goals.
Contribute to the management of department staff and employees’ systemic development and success.
Discuss and develop system policies and procedures.
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable policies.
Other duties as assigned.