Manager of Managed Care Contracting

  •  

Springfield, MA

5 - 7 years

Posted 236 days ago

This job is no longer available.

Job ID 77036 Date posted 02/20/2018 Full / Part Time: Full-Time
Location: Springfield, Massachusetts
Regular/Temporary: Regular

Baystate Health is seeking a Full time Managed Care Contracting Manager

What You Will Do:

Under the oversight of the Director of Managed Care, you will be responsible for a wide variety of duties related to the development, implementation, and ongoing management of the Baystate Health (BH) & Baycare Health Partners (BHP) managed care contracting function. The BH & BHP contracts contribute to the overall mission, vision and strategy of BH with a focus on the IHI triple aim initiative. Primary responsibilities include contract administration, review and analysis of contract proposals, development of managed care strategies, and a liaison role to both external and internal customers and other special projects.

Additional responsibilities will include:

  • Assist in the development of an overall strategy for the managed care activities for BH and BHP. Review contractlanguage, rate and fee proposals, complete market analysis comparisons and evaluate proposal and present to BH & BHP senior leadership and membership
  • Participate, develop, maintain and communicate alternative payment methodologies (risksharing, shared savings, bundle & global payment arrangements, pay for performance programs, etc.)
  • Act as a liaison to internal BH & BHP customers, BHP member committees (Board, CAC, CIAC, R&R and PMAG), and external partners (payer contracting and provider relations management)
  • Disseminate and understand healthcare market and industry changes including impacts due to Affordable Care Act, Massachusetts Health Exchange and regulatory requirements and communicate the impact of these changes to the BH & BHP partners
  • Provide supervision and mentoring of respective managed care staff (Senior Contract Administrator & Contract Administrator Associate positions)
  • Follow-up and address with payers global contracting issues encountered by practices/members. Ensure and interpret payer compliance to contractlanguage and provisions and follow-up on any issues as appropriate
  • Develop, review and communicate operational and clinical requirements. Assist with pay for performance and bonus program settlement and distribution process

What You Will Need:

Bachelor's Degree

PHO, ACO, Hospital & Provider focus or experience

5 years Healthcare, Managed Cared, Payer expertise

Skills:

Excellent communication and presentation skills, financial acumen, relationship building, knowledge of antitrust laws and regulations, ability to tactfully navigate healthcare environment with various key parties

What You Need To Know:

  • Full-time / 40 hours
  • Location: 280 Chestnut Street, Springfield, MA