Care Manager
4 weeks ago
Position SummaryUnder the direction of the Operations Director and Executive Director, this position is responsible for the negotiation, optimization, and operational management of the managed care contracts; Medi-Cal, Medicare, Commercial, PPO, FFS, etc.Schedule:Flexible, may require some evenings and weekendsHours worked per week may exceed 40 hoursPrimary Duties And ResponsibilitiesDirects negotiation of managed care contracts including optimal capitation rates, fee-for-service reimbursements, bonuses, incentives, etc.Reviews, negotiates, and renegotiates payor contracts including rates and contract language provisions.Develops and maintains a complete library of payor contract documentation for each payor including contract summary documents, copies of all fully executed contracts with related amendments, letters, policies, and other operational reference materials.Initiates, fosters, and maintains productive long-term relationships with key payor contacts.Collaborates with other departments to generate quantitative and qualitative data analyses to support negotiations.Interfaces with other divisional managers to ensure operational efficiencies and effective administration of all contractual agreements.Interfaces with internal departments to ensure the completion and submission of contractual documentation to contracted health plans or IPAs (i.e., provider roster, credentialing information).Ensures capture of incentives based on services provided: 120-day health assessments, timely encounter data submission, HEDIS, CHDP services, etc.Negotiates contractual agreements with IPAs and health plans on specialty services such as OB, Mental Health, CPSP, DM Program, etc., based on fee-for-service model and health care outcomes.Able to create and analyze productivity and financial reports, make appropriate recommendations, and corrective action plans.Assists Operations Director in developing the IPA Network with other community clinics.Partners with Operations Director to ensure compliance as required by Health Plans, IPAs, and other regulatory agencies.Participates in organizational meetings as requested.Performs other duties as assigned.Minimum RequirementsProficiency in Microsoft Office applications (Word, Excel, PowerPoint, Access, Outlook)Strong interpersonal and communication skillsAbility to interface with all levels of managementEffective prioritization, multi-tasking, and follow-up skillsStrong attention to detailAbility to work as a team player and independentlyReliable transportationMust be able to travel from facility to facilityThis position requires 10% travel with frequent travel outside the local area.Required Education/Experience And/or Licensure/CertificationKnowledgeable of Managed Care and IPA business modelsMinimum of 5 years' experience in Managed Care with contract negotiations experienceBachelor's Degree in Finance/Accounting, Business Administration, Public Health, or other related studies strongly preferred and/or equivalent work experienceStrong accounting and financial backgroundKnowledgeable of Medi-Cal Managed Care and Medicare compliance, HMOs, and other regulatory agency guidelinesCommitment to goals and philosophy of Northeast Community ClinicValid State Identification#J-18808-Ljbffr
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