Job Description

Managed Care - Contracting Manager

Business Office · Managed Care
Plantation, FL
Health Care
Full Time, Days
Weekly Schedule: Monday - Friday 8:00am - 5:00pm
Bilingual: None
Bilingual Type: N/A
Posted 02/25/2019
Req # 2710
PRIMARY FUNCTION: Participate in the evaluation of contracting opportunities, development of rate proposals, and strategic negotiations to include Risk and Value Based Contracting.  In-depth understanding of contract parameters and performance. 

REPORTS TO: Reports directly to theDirector of Managed Care.

SUPERVISORY RESPONSIBILITIES: Yes

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
  1. Preforms negotiations including Risk, Value Based, Fee for Service, and provider specific contracts.   
  2. Perform contract language review and participate in negotiating language changes/terms/provisions with payors to maximize reimbursement, reduce exposure, and streamline administration.
  3. Manage contract renewal process and ensure timely contract renegotiations.  
  4. Manage department tools and procedures to ensure renewals, updates, and payor information are communicated timely.
  5. Evaluate payor incentive programs.
  6. Identify contracting opportunities within existing payor Agreements.
  7. Evaluate fee schedules and determine potential opportunities.
  8. Monitor contract financial performance including Capitation, Risk, Gainshare, Pay for Performance, and Bonus arrangements.
  9. Research, analyze, and report on market trends in support of company strategic objectives.
  10. Develop and maintain strong payor relationships and facilitate payor meetings.
  11. Perform special projects as requested / all other duties as assigned.

PERFORMANCE REQUIREMENTS:
 
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
 
Education:Bachelor’s Degree in related field.
 
Licensure/Certification:  None
 
*Upon hire, and for the duration of the employment period driver’s license must be active and valid.*
 
Experience:At least 7+ years Managed Care experience which includes working with payors and large groups.  Managed Care Risk Contracting/Value Based Contracting/ Network Development/Provider Relations. 
 
Knowledge, Skills & Abilities:
  1. Skilled negotiator with effective strategic planning and organizational skills
  2. Risk and Value Based Contracting
  3. Knowledge of Statewide Medicaid Managed Care programs
  4. Proficient in research, analysis, and interpretation of financial data and trends
  5. Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
  6. Knowledge of claims, credentialing, and loading processes
  7. Advanced Microsoft Office skills
  8. Effective oral and written communication skills
  9. Ability to manage multiple priorities and projects
  10. Strong interpersonal skills
COMPANY OVERVIEW: Founded in 1955, Pediatric Associates is one of the oldest and most respected pediatric practices in the United States. Pediatric Associates opened its first office in Hollywood, Florida. The Company was one of the first medical groups to introduce satellite office locations in consumer retail locations. They were also one of the first pediatric groups to embrace managed care in the 1970s, collaborating with insurance plans as healthcare partners with the common interest of providing South Florida's children with the best healthcare available. Today, Pediatric Associates is a national leader in pediatric population health management with over 200,000 patients under global risk. Keeping abreast of medical advances and changing lifestyles, Pediatric Associate’s modern facilities offer comprehensive services, including X-ray and state certified laboratories. The Company currently has 33 neighborhood locations, which are staffed by more than 200 employed providers who proudly serve families throughout Miami-Dade, Broward, Palm Beach, St. Lucie, counties, including Tampa and Jacksonville. Pediatric Associates will continue to bring the best possible healthcare service to its patients well into the 21st Century. Ease of access, prompt courteous service and responsiveness to our patients' concerns will always be their primary goal. Pediatric Associates has continued to thrive and today is recognized as one of the premier general pediatric and population health management practices in the United States.

Application Instructions

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