Memorial Healthcare System
Managed Care Manager - FT - Days - MHS
Memorial Healthcare System, Hollywood, Florida, United States, 33024
Overview
Join to apply for the
Managed Care Manager - FT - Days - MHS
role at
Memorial Healthcare System . Location: Hollywood, Florida Summary: Corporate level manager responsible for deploying and contributing to strategic and tactical initiatives for negotiations with national and regional payors. Manages execution of contracting initiatives for integrated delivery system to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers. Responsible for securing negotiations of all contractual provisions, implementing appropriate financial reimbursement models, and supporting operations by collaborating with clinical and operational staff to preserve revenue and address payer imposed challenges. Implement strategic and tactical initiatives to achieve organization and department goals. Responsibilities
Address all single-case negotiations with non-contracted payors in a timely manner. Respond to insurance industry activities, healthcare reform, payer strategies, and changes to the managed care industry to maintain a competitive position. Contribute and coordinate negotiations of ancillary services in concert with the Director of Managed Care for large, complex major-payor negotiations. Enhance, estimate and preserve net revenues and build market share. Assist with related strategies and operations. Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analysts, contract negotiations and issue resolution. Interface with managed care plans on claim reconciliations, trended issues and operational projects. Determine root cause and seek resolution. Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement. Execute and manage legal, financial and operational contract language negotiations in concert with the Director of Managed Care. Execute contracting strategies for Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services for fee-for-service and value-based arrangements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements). Monitor and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors. Escalate, monitor and manage operational issues from Managed Care Revenue Optimization and Accounts Receivable Management; advise and support optimal operational performance by collaborating with other departments and facility staff impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs, etc. Collect information to resolve issues. Competencies
Accountability ,
Building a Business Case ,
Contracting - Managed Care Payors ,
Customer Service ,
Financial Counseling - Patient Services ,
Healthcare Regulatory Environment ,
Leading Change Initiatives ,
Managed Care Payor Management ,
Managing Business Priorities ,
Managing Information ,
People Management ,
Responding to Change ,
Standards of Behavior Education And Certification Requirements
Bachelors (Required) Additional Job Information
Complexity of Work: Requires critical and flexible thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a fast paced, high energy environment while multitasking, working independently and delivering quality outcomes. Must have strong technical & financial skills, negotiating skills and knowledge of contract language (develop, draft and interpret) and reimbursement terms. Extensive Managed Care Industry knowledge and understanding of hospital and insurance industries. Ability to work collaboratively in a collegial environment with multiple stakeholders to achieve department and organization goals. Required Work Experience: 5 years contracting experience with 3 years contracting for hospital, professional services, ancillary facilities or specialty networks. Working Conditions And Physical Requirements
Bending and Stooping = 40% Climbing = 20% Keyboard Entry = 60% Kneeling = 20% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 20% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 20% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 0% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Sitting = 60% Standing = 60% Walking = 40% Audible Speech = 60% Hearing Acuity = 60% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Dust = 20% Computer Monitor = 60% Wet or Slippery Surfaces = 20% Shift Primarily for office workers - not eligible for shift differential Disclaimer:
This job description is not intended to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System
is proud to be an equal opportunity employer committed to workplace diversity. It recruits, hires and promotes qualified candidates without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We offer Veteran’s Preference to former military, reservists and military spouses. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net Seniority level
Mid-Senior level Employment type
Full-time Job function
Health Care Provider Industries: Hospitals and Health Care We are committed to connecting you with opportunities. Referrals increase your chances of interviewing at Memorial Healthcare System.
#J-18808-Ljbffr
Join to apply for the
Managed Care Manager - FT - Days - MHS
role at
Memorial Healthcare System . Location: Hollywood, Florida Summary: Corporate level manager responsible for deploying and contributing to strategic and tactical initiatives for negotiations with national and regional payors. Manages execution of contracting initiatives for integrated delivery system to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers. Responsible for securing negotiations of all contractual provisions, implementing appropriate financial reimbursement models, and supporting operations by collaborating with clinical and operational staff to preserve revenue and address payer imposed challenges. Implement strategic and tactical initiatives to achieve organization and department goals. Responsibilities
Address all single-case negotiations with non-contracted payors in a timely manner. Respond to insurance industry activities, healthcare reform, payer strategies, and changes to the managed care industry to maintain a competitive position. Contribute and coordinate negotiations of ancillary services in concert with the Director of Managed Care for large, complex major-payor negotiations. Enhance, estimate and preserve net revenues and build market share. Assist with related strategies and operations. Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analysts, contract negotiations and issue resolution. Interface with managed care plans on claim reconciliations, trended issues and operational projects. Determine root cause and seek resolution. Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement. Execute and manage legal, financial and operational contract language negotiations in concert with the Director of Managed Care. Execute contracting strategies for Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services for fee-for-service and value-based arrangements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements). Monitor and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors. Escalate, monitor and manage operational issues from Managed Care Revenue Optimization and Accounts Receivable Management; advise and support optimal operational performance by collaborating with other departments and facility staff impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs, etc. Collect information to resolve issues. Competencies
Accountability ,
Building a Business Case ,
Contracting - Managed Care Payors ,
Customer Service ,
Financial Counseling - Patient Services ,
Healthcare Regulatory Environment ,
Leading Change Initiatives ,
Managed Care Payor Management ,
Managing Business Priorities ,
Managing Information ,
People Management ,
Responding to Change ,
Standards of Behavior Education And Certification Requirements
Bachelors (Required) Additional Job Information
Complexity of Work: Requires critical and flexible thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a fast paced, high energy environment while multitasking, working independently and delivering quality outcomes. Must have strong technical & financial skills, negotiating skills and knowledge of contract language (develop, draft and interpret) and reimbursement terms. Extensive Managed Care Industry knowledge and understanding of hospital and insurance industries. Ability to work collaboratively in a collegial environment with multiple stakeholders to achieve department and organization goals. Required Work Experience: 5 years contracting experience with 3 years contracting for hospital, professional services, ancillary facilities or specialty networks. Working Conditions And Physical Requirements
Bending and Stooping = 40% Climbing = 20% Keyboard Entry = 60% Kneeling = 20% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 20% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 20% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 0% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Sitting = 60% Standing = 60% Walking = 40% Audible Speech = 60% Hearing Acuity = 60% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Dust = 20% Computer Monitor = 60% Wet or Slippery Surfaces = 20% Shift Primarily for office workers - not eligible for shift differential Disclaimer:
This job description is not intended to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System
is proud to be an equal opportunity employer committed to workplace diversity. It recruits, hires and promotes qualified candidates without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We offer Veteran’s Preference to former military, reservists and military spouses. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net Seniority level
Mid-Senior level Employment type
Full-time Job function
Health Care Provider Industries: Hospitals and Health Care We are committed to connecting you with opportunities. Referrals increase your chances of interviewing at Memorial Healthcare System.
#J-18808-Ljbffr