Contract Manager – Managed Care

🕒 Ontem

🐊 Florida, Nevada, +1 estados a mais – Remoto

🐊 Florida – Remote 🎰 Nevada – Remote 🏈 Ohio – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Cleveland Clinic

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare • Healthcare Insurance • Wellness

A Cleveland Clinic, localizada em Cleveland, Ohio, é um centro médico acadêmico sem fins lucrativos e de múltiplas especialidades que integra cuidados clínicos e hospitalares com pesquisa e educação. Fundada em 1921 por quatro renomados médicos com a visão de fornecer um atendimento excepcional ao paciente baseado nos princípios de cooperação, compaixão e inovação, a Cleveland Clinic se tornou um dos maiores e mais respeitados hospitais do país. As instalações da Cleveland Clinic podem ser encontradas no nordeste de Ohio, bem como ao redor do país e do mundo, incluindo: Cleveland Clinic Florida Cleveland Clinic Canada Cleveland Clinic Abu Dhabi Cleveland Clinic Lou Ruvo Center for Brain Health - Las Vegas O sistema de saúde da Cleveland Clinic inclui oito hospitais regionais, 16 centros de saúde familiar, um hospital infantil para reabilitação e um hospital afiliado. A Cleveland Clinic é credenciada pela The Joint Commission, o maior credenciador de organizações de saúde dos Estados Unidos. Nossos centros de saúde familiar oferecem: Atendimento ambulatorial Cuidados primários Numerosas subespecialidades Diversas localizações Todos os nossos hospitais, centros de saúde familiar, clínicas ambulatoriais e programas de assistência médica domiciliar são também acreditados pela The Joint Commission sob seu programa de acreditação hospitalar.

Descrição

• Negotiate and renegotiate managed care contracts • Oversee and coordinate administrative, legal, operational, and financial issues related to contract negotiations • Maintain a comprehensive payer and managed care intelligence database • Develop responses to requests for proposals from managed care plans • Facilitate managed care educational and training materials for payer contract services, physicians, office managers, and participating provider personnel • Manage a defined range of payer agreements, including PPO, ancillary, physician, and other managed care agreements • Update rates and contract terms • Assemble and coordinate contract negotiation teams across legal, finance, payer contract services, and operations • Assess new payer relationships against standard CCHS terms and contract objectives • Recommend updates to standard CCHS contracts and business terms • Propose alternate legal language • Coordinate contract changes suggested by CPP, hospitals, legal, risk, and UM/QA • Evaluate opportunities and financial terms for hospital and physician contracts • Maintain chronology of managed care proposals and counterproposals • Assess legal risks in contract provisions • Draft responses and fulfill additional information requests from managed care plan representatives • Develop proposals responding to managed care plan requests for proposals • Provide strategic and financial judgment to achieve profitable payer growth • Review quantitative models evaluating proposal impacts on hospitals and physician practice managers • Support continuous assessment and improvement of care and service quality • Participate in annual budget development and develop contracting goals, strategies, activity plans, and projections • Work with marketing to develop and promote new products and build revenue in existing products • Perform other duties as assigned

🎯 Requisitos

• Must reside in Ohio, Florida or Nevada • Bachelor's Degree • Three years of contracting experience in a payor, provider or other relevant contract setting, including negotiation of financial/contract terms and development of contract language • Working knowledge of leading-edge managed care methodologies and practices • Working knowledge of managed care operations, physician office practices, hospital admitting, billing, and utilization review operations • Negotiation skills, outstanding analytical ability and financial skills • PC skills and experience with Microsoft Office products • Managed care experience • Experience across multiple service lines, such as heart and vascular, transplant, and women’s health • Health system-based managed care contracting experience • Hands-on experience negotiating and managing health insurance contracts • Ability to communicate and exchange accurate information • Ability to perform work in a stationary position for extended periods • Ability to work with physical records or operate a computer or other office equipment • Must follow standard precautions and use personal protective equipment as required • Must comply with the influenza prevention program, including annual vaccination or approved exemption

🏖️ Benefícios

• Full-time employment • Remote work from 8:00 a.m.–5:00 p.m. • Annual half-day, on-site team meeting in Cleveland • Annual influenza vaccination program or approved exemption • Drug-free workplace with controlled-substance testing after offers • Equal employment opportunity workplace

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