Manager, Managed Care Contracting


HMH HOSPITALS CORPORATION Edison Requisition # 2021-89673 ShiftDay StatusFull Time with Benefits Weekend WorkNo Weekends Required HolidaysNo Holidays Required On CallNo On-Call Required Shift Hours8:30-5:00 Address343 Thornall Street, Edison, 08837

View Saved

Overview

How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

Conduct network managed care contracting initiatives for HMH Physicians, Physicians Related Entities, Urgent Care and Facility and Professional Behavioral Health Services. Work with Vice President - Managed Care in the coordination and review of financial analysis for assigned entities. Under the direction of Vice President-Managed Care handle the negotiation of financial and contractual provisions for the assigned network entities within HMH Legal contractual parameters, implementation of reimbursement, fee schedules, contractual terms, coordination of credentialing and all operational related processes by both HMH and Managed Care Organization within department and organizational strategic initiatives and timelines. Provide operational support functions with our internal and external matrix partners.

Responsibilities

A day in the life of Manager, Managed Care Contracts at Hackensack Meridian Health includes:

  • Represent HMH Physician, Physicians Related and Behavioral Health entities in network contractual negotiations within departmental and organization strategic initiatives and timelines.
  • Manage the negotiation and contracting initiatives for all new physician, physician related and behavioral health related entities ensuring respective business plans for volume, revenue and growth are enhanced by HMH¿s contracting efforts with effective dates within strategic timelines.
  • Assure compliance with HMH Legal required language parameter through document review, redlining, coordination of language changes and coordination of final HMH legal review and approval process through full execution. 
  • Managed and coordination of HMH assigned entities consolidation initiatives within strategic goals/timelines.
  • Request, review, and financial analytics and contract modeling requests, as required.
  • Act as a liaison with legal counsel and other operational departments including Finance and matrix partners.
  • Under the direction of VP ¿ Managed Care coordination departmental/organizational initiatives within the network and matrix partners.
  • Develops, coordinates and communicates the status of open negotiations and completed agreements/amendments to appropriate internal staff and internal and external matrix partners.
  • Develop and maintain positive working relationships with the decision-makers and operating departments of various managed care organizations and internal clients including Legal and Finance.
  • Educate assigned entities on requirements of managed care agreements/amendments.
  • Develop, interpret, monitor and implement credentialing departmental policies and procedures and collaborate and act as a liaison to HMH¿s credentialing entities and internal staff. Establish and monitor to assure timely credentialing. 
  • Evaluate and resolve contractual and operational issues with Managed Care companies.
  • Ensure contractual requirements and rates are disseminated to appropriate users and matrix partners. 
  • Negotiate, document, and disseminate single case agreements with non-contracted Managed Care companies, as required. 
  • Coordinate the completion of any settlement agreements for assigned entities, as required. 
  • Other duties and/or projects as assigned.
  • Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

  • Bachelor's degree.
  • At least 10+ years of experience in all aspects managed care physician, behavioral health facility/professional, physician related and urgent care entities negotiations, contracting including language and operations.
  • Experienced and strong proficiency in the negotiation of contractual/managed care agreement language required.
  • Must have excellent analytical skills.
  • Must possess good oral and written communication skills.
  • Must display professional attitude when interacting with internal and external customers and matrix partners such as physicians, behavioral health hospital and ancillary administration, and managed care plans.
  • Must be able to multitask to handle a fast-paced work environment.

Education, Knowledge, Skills and Abilities Preferred: 

  • Bachelor's Degree in Business. 

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

 

Our Network

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.