Associate Director Managed Care Contracting
Atrium Health, Charlotte, North Carolina, United States, 28245
Department:
13212 Enterprise Corporate - Managed Health Clinical insights & Operations: Contract Management
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
8am-5pm, M-F, Remote. Variability in hours based on various project requirements.
Pay Range:
$51.05 - $76.60
Job Overview Responsible for managed care portfolio performance for assigned payors. Implementation of contracting strategy for the System. Monitor contract performance versus expected, and recommend any action needed. Completes multi-level analysis of contract language understanding current implications to the Total Enterprise. Able to review complete existing and proposed contract language and identify current risk and impact to the Total Enterprise.
Essential Functions
Assists in the development and implementation of the System's strategies and objectives related to managed care contracting for assigned Managed Care Organizations.
Responsible for rate and language negotiation of assigned payor agreements. Negotiates rate and language of major payor agreements with AVP support. Assists with the development of negotiation strategy for major payors. Negotiates rate and language of major payor agreements independently when the scope of the negotiation is limited.
Assists in negotiations and maintenance of collaborative/value based managed care agreements including but not limited to provider tiering and performance reporting.
Monitors, regularly reviews and reports financial and operational performance of assigned payor contracts versus expectations. Recommend any action needed as a result of contract performance.
Gathers and analyzes data and apply methodologies. Draw preliminary conclusions and project application(s). Identify cross-application of data or analysis, directing efforts of other associates, as needed.
Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships.
Provides System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives. Draw conclusions and recommend any action needed based on analysis of industry trends.
Physical Requirements Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.
Education, Experience and Certifications Bachelor's degree required, Master's degree preferred (MBA or MHA preferred). Minimum of 5 years experience as a contract negotiator with a large provider or 7 years small provider or payor experience as a contract negotiator with a Bachelor's degree. –OR– Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Master's degree.
Our Commitment to You Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work.
Compensation
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and More
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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13212 Enterprise Corporate - Managed Health Clinical insights & Operations: Contract Management
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
8am-5pm, M-F, Remote. Variability in hours based on various project requirements.
Pay Range:
$51.05 - $76.60
Job Overview Responsible for managed care portfolio performance for assigned payors. Implementation of contracting strategy for the System. Monitor contract performance versus expected, and recommend any action needed. Completes multi-level analysis of contract language understanding current implications to the Total Enterprise. Able to review complete existing and proposed contract language and identify current risk and impact to the Total Enterprise.
Essential Functions
Assists in the development and implementation of the System's strategies and objectives related to managed care contracting for assigned Managed Care Organizations.
Responsible for rate and language negotiation of assigned payor agreements. Negotiates rate and language of major payor agreements with AVP support. Assists with the development of negotiation strategy for major payors. Negotiates rate and language of major payor agreements independently when the scope of the negotiation is limited.
Assists in negotiations and maintenance of collaborative/value based managed care agreements including but not limited to provider tiering and performance reporting.
Monitors, regularly reviews and reports financial and operational performance of assigned payor contracts versus expectations. Recommend any action needed as a result of contract performance.
Gathers and analyzes data and apply methodologies. Draw preliminary conclusions and project application(s). Identify cross-application of data or analysis, directing efforts of other associates, as needed.
Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships.
Provides System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives. Draw conclusions and recommend any action needed based on analysis of industry trends.
Physical Requirements Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.
Education, Experience and Certifications Bachelor's degree required, Master's degree preferred (MBA or MHA preferred). Minimum of 5 years experience as a contract negotiator with a large provider or 7 years small provider or payor experience as a contract negotiator with a Bachelor's degree. –OR– Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Master's degree.
Our Commitment to You Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work.
Compensation
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and More
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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