Program Manager, Managed Care

Job Title & Specialty Area: Program Manager, Managed Care Department: Managed Care Job Type: This is a remote position with regular on-site meetings (i.e. "hybrid"). Why Children's Health? At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal. Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being. Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all. Summary: The Program Manager for Managed Care will facilitate analysis, preparation, and scheduling for joint operation committee meetings with managed care payors, ensuring timely resolution and escalation to leadership as needed. This role supports Managed Care Contracting and Revenue Cycle by gathering, analyzing, and sharing data on managed care payors' compliance with payment provisions of their contracts with CHST providers. The manager will develop and implement strategies for improving payer contract compliance, resulting in increased net revenue. Additionally, the position manages or provides support to special programs, including cost-share plans, out-of-state Medicaid, and the CHST international patient process, managing financial requirements and ensuring adequate payments prior to services being rendered. The role also involves identifying payor updates and requirements and providing education to impacted departments, as well as analyzing payor trends for assigned CHST programs/service lines to identify root causes. The Program Manager will manage and provide MC Contracting support for CHST programs/service lines and oversee payor contract adherence, providing a comprehensive examination and process to ensure payors comply with all contractual obligations. Utilizing applications and tools to support performance management reporting, the manager will provide an overview of key performance indicators to internal stakeholders.