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Contract Manager, Managed Care

Company: UMass Memorial Health Care
Location: Worcester
Posted on: November 22, 2021

Job Description:

Requisition #: 216247 Title: Contract Manager, Managed Care Department: Managed Care Location: 1 BIOTECH PARK, WORCESTER, MA Posting Date: July 30, 2021 Shift: Days Status: Exempt Hours: 40 Monday-Friday business hours; some remote days to be discussed at interview Position Summary: Responsible for the implementation and renewal of managed care contracts for the medical center and physicians. Assists in the renewal of ancillary service and member hospital managed care contracts. Major Responsibilities: * Responds to all inquiries relating to managed care contracts from medical center personnel, physicians and/or physicians office staff. Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system. * Resolves issues relating to health plan credentialing, claims payment, referral management, and various administrative issues. * Coordinates with Managed Care Provider Relations staff communication of contractual requirements, updates on policy and operational changes and other contract-related information to various departments within the organization. * Coordinates site visits required for credentialing for new and existing programs. * Acts as primary liaison with managed care plans in addressing operational issues arising under the managed care contracts. Meets regularly with representatives from the managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and Umass Memorial Medical Group personnel. * Manages contracts to ensure compliance and, with input from the Director, Legal, Finance, and other departments as appropriate, is responsible for renewing and renegotiating contract terms. Assists with financial analysis and negotiation of risk contracts. Assists in contracting for ancillary services, including home health & hospice and MRI services, and affiliate hospital risk contracts. Helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved. Position Qualifications: License/Certification/Education: Required: * BS degree or equivalent in Business, Health Care Administration, or Managed Care Administration. Experience/Skills: Required: * Five year's experience in hospital, physician office, clinical or managed care setting; thorough understanding of clinical operations, health care terminology, and current market conditions. * Three years direct managed care-contracting experience, with emphasis on analyzing and negotiating risk contracts and thorough understanding of managed care financial arrangements and boilerplate negotiations. * Experience with risk contracting preferred. * Good knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred. Excellent verbal and written communication skills. * Proficiency with Microsoft Office applications. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Keywords: UMass Memorial Health Care, Worcester , Contract Manager, Managed Care, Executive , Worcester, Massachusetts

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