Contract Manager – Managed Care

🔥 17 hours ago

🐊 Florida, Nevada, +1 more states – Remote

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

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Cleveland Clinic

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Cleveland Clinic is a not-for-profit, multispecialty academic medical center located in Cleveland, Ohio. Founded in 1921, it integrates clinical and hospital care with research and education, earning a reputation as one of the largest and most respected hospitals in the country. The health system includes multiple facilities across Northeast Ohio and other locations globally, providing a wide range of specialized services such as cancer care, women's health, dermatology, and cardiovascular care. Cleveland Clinic is accredited by The Joint Commission, which underscores its commitment to high standards in healthcare delivery.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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