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Managed Care Contractor

Job purpose

Under the direction of the Director of Managed Care, the Managed Care Contractor plans, organizes, administers, and directs the managed care contracting strategy for HealthOne Alliance (HOA); analyzes and negotiates contractual language; negotiates reimbursement with managed care plans, physicians, providers, hospitals and ancillaries; serves as liaison between managed care staff and Valence Health for management of contract database. Travel is required for this position.

Duties and responsibilities

• Analyze and compare competitiveness of proposed HealthOne Alliance and Alliant Health Plans existing and new contracts.
• Liaison with hospitals, providers and other affiliated organizations in addition to managed care organizations regarding issues pertaining to managed care. Recruit and manage the network and develop the contracts.
• Analyze proposals and counter proposals from providers to ensure market competitiveness.
• Participates in financial analysis of revenue projections based on contractual rates with payors, adverse trends, terms and appropriate recommendations or conclusions.
• Work with the Network Management/Development team and field contractors to understand contract language system validity and handle negotiations when required.
• Act as liaison between HOA Contracting and Valence Health for management of the contract database.
• Plan, organize, administer, and direct contracting strategy for HOA, determining marketplace position, plan participation, and contract requirements.
• Direct negotiation of managed care contracts for HOA including negotiation of appropriate capitation, fee-for-service reimbursements, and contractual language.
• Present managed care strategy to executive leadership and educate team on determined strategy to obtain buy-in and support.
• Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback regarding financial and/or operational issues with payors.
• Work with Provider Relations and Operations to load and train HOA and AHP Network Providers.
• Assist in reviewing managed care legal contract language and negotiating language to meet agreed parameters with legal counsel to lessen risk and improve operational efficiencies.
• Perform special projects and other duties as assigned by executive leadership including committee involvement.

Qualifications

• Bachelor degree in healthcare, business, finance or related area
• A minimum of two-years’ experience in the multi-specialty areas of health insurance, plan design, fee schedules, plan providers and healthcare
• Comprehensive knowledge of the requirements of contract management
• Superior decision-making skills
• Honed negotiating skills, including ability to close contract deals
• Ability to persuade and influence
• Ability to maintain confidentiality
• Ability to initiate and maintain professional relationships

Competencies

• Ethics - Honest, accountable, maintains confidentiality
• Reliability - The extent to which the employee can be depended upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.
• Sense of Urgency - Meets deadlines, establishes appropriate priority, gets the job done in a timely manner
• Communication - Communicates well, delivers presentations, has good listening skills
• Initiative - Takes action, seeks new opportunities, strives to see projects to completion
• Results Driven - Defines appropriate goals, works toward achieving goals, articulates vision and steps for achievement
• Interpersonal Relations - Establishes and maintains effective working relations with employees and others within and outside the organization
• Job knowledge - Knowledge of products, policies and procedures; OR knowledge of techniques, skills, equipment, procedures, and materials.
• Problem Solving & Decision Making - Displays ability to define a problem, develops workable and realistic alternatives, and selects appropriate alternative to resolve problem. Decisions made are generally correct, and the time taken to make such decisions is reasonable.
• Product Expertise - Knows product features, understands marketplace, shares expertise with others

Physical, Mental, Environmental & Working Conditions

Moderate amount of walking, sitting, and writing. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job duties. Need for flexibility and adaptability to change. Candidate must be self-disciplined and a self-starter and able to work independently with a flexible work schedule.

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 3/29/2017 8:34:40 PM