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Managed Care Contract Manager in Dallas, TX at Cornerstone Healthcare Group

Date Posted: 11/22/2018

Job Snapshot

Job Description

Who We Are

Cornerstone Healthcare Group is a leading healthcare provider committed to improving the health and well-being of patients by providing an environment of continuous process improvement, teamwork, integrity, fiscal responsibility and endless customer service. Cornerstone is headquartered in Dallas and owns 19 long term acute care hospitals in six states, as well as behavioral health hospitals and senior living facilities.

Why Work for Us?

Our hospitals offer competitive compensation and benefits, but that is not why our employees come to work for us. As a Cornerstone employee, you are truly a valued contributor to our team. It is no wonder why our employees gave us high scores in both overall satisfaction and employee engagement in our latest Cornerstone Employee Partnership Survey.

Our Core Values are woven into the fabric of our culture and engrained in our employees and how they perform their jobs every day.

Responsibilities

The Managed Care Contract Manager evaluates, analyzes, negotiates, implements, and monitors contract rates and terms within established contract parameters and timeframes.

Position Duties:

  • In collaboration with leadership, identifies appropriate contracting and re-contracting opportunities and initiates discussions with key constituents. For new relationships or service lines, performs business and market analysis to determine viability of contracting. Collaborates with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with enterprise goals.
  • Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals. Collaborates with internal staff on modeling of rate proposals. Ensures contract terms can be administered and monitored in a cost effective manner. Effectively interfaces with management, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
  • Manages all aspects of the contract life-cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts cross-functionally, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
  • Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
  • Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serves as the expert on all terms of the payer contract for both internal and external parties.
  • Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
  • Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
  • Performs miscellaneous job related duties as requested.

Qualifications

Minimum Qualifications:

  • Ability to project a professional image
  • Apply professional standards of practice in the work environment to both internal and external customers
  • Knowledge of regulatory standards, compliance requirements, hospital policies and procedures, and third party requirements
  • Familiar with medical terminology
  • Strong understanding and working knowledge of Medicare and Commercial admission regulations
  • Familiar with third-party admission and continued stay criteria
  • Working knowledge of personal computer and software applications used in job functions (Word processing, graphics, databases, spreadsheets, etc.)

Education and/or Experience:

  • Minimum 3- 5  years’ experience in Managed Care experience
  • Minimum of three (3) to five (5) years’ experience of single case agreement/letter of agreement negotiations