Job description

Department Managed Care Job Summary This leader has operational accountability and oversight, and manages the daily operational contract management activities of the Managed Care department. In this role, the leader sets the tone and models positive leadership behavior, while ensuring successful completion of teamwork tasks, projects, and responsibilities in support of departmental and organizational goals. Required Qualifications - Require a Bachelor’s degree in Business, Accounting, Finance, or other relevant area. - Require a minimum eight (8) years of managed care contracting experience in a similar size health care system or large health care payer Preferred Qualifications - Prefer demonstrated knowledge of all aspects of a health care delivery system, industry contracting practices and administration, and contract analysis. - Prefer the ability to build and maintain effective relationships with payors and leverage interpersonal influences to achieve organizational goals. - Prefer the ability to build strong relationships and deliver high quality service to all internal and external customers. - Prefer demonstrated proficiency in PC-based software, the ability to instruct staff on complex analysis, and develop complex reports. - Prefer demonstrated organizational and time management skills to maximize productivity and outcomes. - Prefer demonstrated written and oral communication skills, to include composing contract language correspondence, patient correspondence and reports. - Prefer the ability to provide leadership and mentoring by guiding individuals and teams towards desired outcomes, setting high performance standards and delivering industry-leading quality services. - Prefer demonstrated experience with negotiation of contracted rates and language including redlining of contracts. - Prefer proficiency in payment methodologies such as DRG, APR-DRG, Case Rates, EAPG, Per Diems, and Fee Schedules. Mandatory Education BD: Bachelor Degree Preferred Education M D: Masters Degree

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