Additional Information About the RoleBJC is seeking a Manager of Managed Care Contracting. This role oversees value-based contracting across the organization, including negotiating with insurance providers and implementing contract agreements. The ideal candidate will have prior experience with value-based contracts and a strong understanding of coding and documentation practices.
Must be located in the greater St. Louis area.
Role PurposeIn collaboration with leadership, the Managed Care Contracting Manager manages and leads the contract negotiations with the Managed Care Organizations (MCOs), including rate and language discussions in accordance with established guidelines and aligned with BJC strategic goals. This position develops and maintains strong relationships with the Managed Care Organizations (MCOs). This position also collaborates with the HSOs in order to identify challenges and opportunities for improvement around contract performance.
ResponsibilitiesManages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.Negotiates complex managed care contracts on behalf of the BJC HSOs including hospitals, physicians, home care, behavioral health and other ancillary providers; leads contract discussions with managed care organizations, including reviewing and drafting contract language provisions that protect BJC's revenue and improve administrative functions and negotiating rates within established guidelines.Facilitates problem solving of identified contractual and operational issues in collaboration with managed care organizations and internal stakeholders; identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts; leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems.Minimum RequirementsEducationBachelor's DegreeExperience5-10 yearsSupervisor Experience2-5 yearsPreferred RequirementsEducationMaster's DegreeExperience10+ yearsSupervisor Experience5-10 years Benefits and Legal StatementBJC Total RewardsAt BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.
- Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
- Disability insurance* paid for by BJC
- Annual 4% BJC Automatic Retirement Contribution
- 401(k) plan with BJC match
- Tuition Assistance available on first day
- BJC Institute for Learning and Development
- Health Care and Dependent Care Flexible Spending Accounts
- Paid Time Off benefit combines vacation, sick days, holidays and personal time
- Adoption assistance
To learn more, go to our Benefits Summary*Not all benefits apply to all jobs
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.
