Job Description: Overview
Manager of Managed Care
The Manager of Managed Care is responsible for assessing the managed care contracting needs of each assigned facility and managed care readiness for key healthcare initiatives. Provides support and guidance to facilities in the areas of managed care contracting, managed care relationships, developing an infrastructure to support managed care business, payor mix, and contract operations. Assists in the development of a Division's managed care contracting initiatives to include preparing Facilities for Value Based Contracting. Develops training materials and provides on-site support to facility staff, when needed. Evaluates reimbursement rates and reimbursement methodology to result in a positive impact to Facility's net revenue growth.
Assists facilities in managed care contracting and revenue enhancement strategies for their area.
Uses data to determine areas where rates can be potentially improved.
Review rates and renewal dates by payer and facility to ensure facilities are negotiating rates timely and that rate requests are appropriate. Owns negotiation, when appropriate.
Provides guidance to facilities regarding development of managed care relationships and rate negotiation.
Assists facilities with ensuring managed care contracts are acceptable according to organization's required standards, and in responsible for pre-screening managed care contract terms prior to uploading to MediTract for legal review. Assists in execution and implementation of contract changes.
Negotiates contracts for startup facilities and facilities changes from self-pay model to a more diversified business model.
Provides guidance on payor-related documents and forms needed for network participation and advises on making changes to network status including but not limited to: services offered, locations, and participating products.
Assists facilities with issues with major payors such as contract disputes and denials.
Work with facilities to monitor the impact of specific managed care strategies and contracts. Evaluates opportunities to grow net revenue by contracting or terminating contracts with managed care payors.
Assist business development staff with ensuring volume growth in key payors and a balanced payor mix.
Provide ongoing training to facility staff on-site or via regularly scheduled conference calls.
Works with Vice President of Managed Care to maintain current knowledge of managed care trends and changes and ensures facilities are prepared and compliant.
Works with division leadership and Corporate UM/Intake/Business Office staff to ensure payer related challenges and opportunities are dealt with collaboratively for resolution.
Works with facility to develop managed care pitch to secure expanded business.
Surveys managed care organization's needs and assists in evaluating as a potential growth opportunity.
Bachelor's degree in business or healthcare related field.
Minimum 5 years' contract experience in a health care facility/system or managed care organization. Previous Behavioral healthcare experience preferred.
Knowledge of laws, regulations and rules related to managed care.
Knowledge of major payors, reimbursement, and value based contracting models.
Effective and accurate oral and written communication skills. Ability to communicate interdepartmentally to include Business Office, UM, Clinical, Finance Operations, Compliance, Legal, and Senior Leaders.