Description
NEGOTIATE AND COORDINATE MANAGED CARE CONTRACT OPERATIONS AND MONITORING, INCLUDING MAINTENANCE AND COMPLIANCE; MANAGE ALL QUALITY/RISK/HEALTH EQUITY INCENTIVES, BE THE MANAGED CARE LIASION WITH OPERATIONS INCLUDING THE EMPLOYED AND INDEPENDENT PHYSICIAN MEDICAL GROUPS; RECOMMEND MANAGED CARE CONTRACT SOLUTIONS; CULTIVATE AND MANAGE POSITIVE RELATIONSHIPS WITH INTERNAL PROVIDERS AND EXTERNAL HEALTH PLANS#AND PARTIES INVOLVED IN MANAGED CARE CONTRACTS AND CORRECT CLAIMS PAYMENT. # 1. Work closely with the Director of Managed Care on tracking and monitoring the operation and maintenance of the financial and operational performance of managed care contracts for Valley Health Systems#and Valley Health Partners PHO. 2.#Work with the Director and negotiate terms, conditions and rates of the smaller managed care contracts within VHS and VHP#contracting parameters and then manage their operational effectiveness. 3. Provide analyses on the physician fee schedules and benchmark them against national and state standards. 4. Track and present ongoing operational results in a concise format with suggestions for improvements in specific financial terms. 5. Use the contract management software to operationally benchmark managed care contract terms and conditions and track operational results by payor in order to plan, coordinate, and prepare timely analyses of existing managed care contracts. 6. Be the liaison with health plans and other parties involved in the operational end of the managed care contracts, including running standing joint meetings.# 7. Provide timely, accurate, and pertinent information to the Director to be used by Finance, operating managers, and the Boards of Directors. Education: Bachelor#s Degree in Business or Health Care Administration Experience: Preferred#five years# experience with managed care contracts# terms and conditions, including incentives, or related finance, medical economics, claims, operations or quality experience.
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