AdventHealth-posted 3 months ago
Full-time • Mid Level
Shawnee, KS
Hospitals

This position will provide leadership for managed care strategy, contracting and contract management for the five hospitals, ancillary services, and employed physicians. The role involves facilitating understanding of managed care within hospital departments, medical practices, and nursing and rehab centers. It includes managing relationships between managed care organizations, hospitals, ancillary services, and employed physicians, continuously re-evaluating managed care contracts, analyzing market share, profitability, and competitiveness. Other duties include participating in leadership meetings, auditing and analyzing data for all physician/provider credentialing records, and facilitating timely renegotiation and rate increases when appropriate. The position also monitors financial, operational, and strategic impact of managed care relationships to identify areas for improvement and works with patient financial services on managed care claim-related issues. Additionally, the role assists the CFO with operational or special projects, including annual managed care budgets and market summary overviews, and coordinates and maintains credentialing documents necessary for credentialing and re-credentialing of all physicians/providers.

  • Provide leadership for managed care strategy, contracting, and contract management.
  • Facilitate understanding of managed care within hospital departments, medical practices, and nursing and rehab centers.
  • Manage relationships between managed care organizations, hospitals, ancillary services, and employed physicians.
  • Continuously re-evaluate managed care contracts, analyzing market share, profitability, and competitiveness.
  • Participate in leadership meetings and present credentialing status for all groups.
  • Audit and analyze data for all physician/provider credentialing records, documents, and files.
  • Program applications to generate reports ensuring the accuracy of physician/provider records.
  • Facilitate timely renegotiation and rate increases when appropriate.
  • Monitor financial, operational, and strategic impact of managed care relationships to identify areas for improvement.
  • Work with patient financial services on managed care claim-related issues.
  • Assist the CFO with operational or special projects, including annual managed care budgets and market summary overviews.
  • Coordinate and maintain credentialing documents necessary for credentialing and re-credentialing of all physicians/providers.
  • Bachelor's Degree
  • 5 plus years of health care leadership experience required in managed care with an emphasis on contracting, contract administration, and strategic planning for hospital, ancillary, and physician services.
  • Master's Degree
  • Benefits from Day One
  • Career Development
  • Whole Person Wellbeing Resources
  • Mental Health Resources and Support
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