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MANAGER OF MANAGED CARE

Owensboro Health

Location: 42301
Type: Non-Remote
Posted on: January 17, 2022
This job is no longer available from the source.
MANAGER OF MANAGED CARE Leadership Hours: 8a-5p Days - Full-time Paygrade/Wages/Salary Info: OH 2013-79 - 46062A
Job Summary Provides strategic leadership, financial, and administrative oversight of Managed Care contracting with commercial payors on behalf of Owensboro Health and their other companies (i.e. Medical Group, other hospitals) in concert with the Director of Financial Services and Vice President of Finance. # Job Responsibilities Oversees and participates in the development, negotiation, implementation, monitoring, and management of all Owensboro Health managed care agreements. Evaluates and recommends financial parameters and reimbursement methodologies. Implements new managed care programs in conjunction with physicians, department heads, and hospital administration. Keeps staff and physicians apprised of developments in the managed care marketplace. Directs and participates in financial analysis of revenue projections based on contractual rates with payors, adverse trends, terms, and appropriate recommendations or conclusions. Analyzes and monitors financial aspects of existing managed care contracts. Utilizes analysis for feedback on contract renewals, renegotiations, or termination. Makes recommendations regarding participation or non-participation with new or existing agreements. Establishes and leads Owensboro Health Managed Care Committee. Provides feedback to Owensboro Health Managed Care Committee regarding financial and/or operational issues with payors. Develops and audits payor fee schedules based on negotiated reimbursement rates by contract and/or product line. Coordinates the communication of fee schedules to Patient Financial Services and other departments in the organization as needed. Maintains and distributes participation information by payor by network product for all signed contracts, contracts under-negotiation, or plans not being negotiated by Owensboro Health. Reviews managed care legal contract language and negotiating language to meet agreed to parameters with legal counsel to lessen risk and improve operational efficiencies. Accountable for strategic planning for other reimbursement and profitability endeavors with sub-contract arrangements and pay for performance initiatives related to managed care contracts. Manages and directs Managed Care department including personnel management, setting of departmental policies, goals and objectives, and preparation, administration, and control of departmental budget. Collaborates with all clinical departments of Owensboro Health and all administrative departments within Owensboro Health on managed care issues. Assembles information and prepares materials for presentation to committees, clinic directors, administrators, and managed care networks. Advises Leadership on matters pertaining to managed care. Liaisons with hospitals, other affiliated organizations, and managed care organizations regarding issues pertaining to managed care. Manages the design, implementation, and maintenance of the managed care rates in the Electronic Medical Record and Decision Support information systems. Responsible for loading of Owensboro Health contracts. Designs, manages, and implements in-service training on managed care contracts to the administration staff. Monitors and keeps current on federal and state laws and regulations as they apply to health benefit contracts. Tracks and monitors all contract activity for assigned market area. Maintains good rapport and cooperative working relationships with clients. Works collaboratively with the Owensboro Health Reimbursement staff to ensure contract compliance and successful implementation of any Medicaid and Medicare managed care agreements. Qualifications Bachelor#s degree or higher in Accounting required upon hire OR Bachelor#s degree or higher in Business Administration required upon hire OR Bachelor#s degree or higher in Finance required upon hire OR Bachelor#s degree or higher in related field required upon hire A combination of education, training and experience may be considered in lieu of degree. A minimum of 5 years# relevant experience required No licensure/certification/registration required Skills and Attributes Requires critical thinking skills and decisive judgment. Works under minimal supervision. Must be able to work in a stressful environment and take appropriate action. Physical Demands Standing: Occasionally Walking: Occasionally Sitting: Frequently Lifting 0-25 lbs: Rarely Lifting 25-75 lbs: Never Lifting over 75 lbs: Never Carrying 0-25 lbs: Rarely Carrying 25-75 lbs: Never Carrying over 75 lbs: Never Pushing/Pulling 0-25 lbs: Rarely Pushing/Pulling 25-75 lbs: Never Pushing/Pulling over 75 lbs: Never Climbing: Rarely Bending/Stooping: Rarely Kneeling: Rarely Crouching/Crawling: Rarely Reaching: Occasionally Talking: Frequently Hearing: Occasionally Repetitive Foot/Leg Movements: Never Repetitive Hand/Arm Movements: Frequently Keyboard Data Entry: Frequently Running: Never Vision: Depth Perception: Frequently Vision: Distinguish Color: Frequently Vision: Seeing Far: Frequently Vision: Seeing Near: Frequently Owensboro Health Core Commitments INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers. RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community. TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future. INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health. SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do. EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.