Managed Care Contract Negotiator

4 weeks ago

Dubai, Dubai, United Arab Emirates ClickJobs Full time
Job Title: Managed Care Manager

Job Summary:

We are seeking a highly skilled Managed Care Manager to join our team at ClickJobs. The successful candidate will be responsible for negotiating, optimizing, and managing managed care contracts with various payors, including Medi-Cal, Medicare, and Commercial plans.

Key Responsibilities:

  • Negotiate and optimize managed care contracts to ensure optimal capitation rates, fee-for-service reimbursements, and bonus incentives.
  • Review, negotiate, and renegotiate payor contracts, including rates and contract language provisions.
  • Develop and maintain a comprehensive library of payor contract documentation, including contract summary documents, fully-executed contracts, and related amendments.
  • Foster and maintain productive long-term relationships with key payor contacts.
  • Collaborate with other departments to generate quantitative and qualitative data analyses to support negotiations.
  • Interface with internal departments to ensure the completion and submission of contractual documentation to contracted health plans or IPAs.
  • Capture incentives based on services provided, including 120-day health assessments, timely encounter data submission, HEDIS, and CHDP services.
  • Negotiate contractual agreements with IPAs and health plans on specialty services, such as OB, Mental Health, CPSP, and DM Program, based on fee-for-service models and healthcare outcomes.
  • Analyze productivity and financial reports, make recommendations, and develop corrective action plans.
  • Assist the Operations Director in developing the IPA Network with other community clinics.
  • Partner with the Operations Director to ensure compliance with Health Plans, IPAs, and regulatory agencies.
  • Participate in organizational meetings as requested.

Requirements:

  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Access, Outlook)
  • Strong interpersonal and communication skills
  • Ability to interface with all levels of management
  • Effective prioritization, multi-tasking, and follow-up skills
  • Strong attention to details
  • Ability to work as a team player and work independently
  • Reliable transportation
  • Must be able to travel from facility to facility
  • This position requires 10% travel with frequent travel outside the local area.

Education/Experience:

  • Knowledgeable of Managed Care and IPA business models
  • Minimum of 5 years' experience in Managed Care with contract negotiation experience
  • Bachelor's Degree in Finance/Accounting, Business Administration, Public Health, or other related studies strongly preferred and/or equivalent work experience
  • Strong Accounting and Financial background
  • Knowledgeable of Medi-Cal Managed Care and Medicare compliance, HMO's, and other regulatory agency guidelines
  • Commitment to goals and philosophy of Northeast Community Clinic
  • Valid State Identification

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