Contract Manager, Managed Care

Professional Admin/Clinical Worcester, Massachusetts


Description

Position at UMass Memorial Health

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 214956

Title: Contract Manager, Managed Care

Department: Managed Care

Location: UMass Memorial Medical Center -1 BIOTECH PARK, WORCESTER, MA

Posting Date: June 7, 2021

Shift: Days

Status: Exempt

Hours: 40

Monday-Friday business hours; some remote days to be discussed at interview 

Position Summary:
 
Responsible for the implementation and renewal of managed care contracts for the medical center and physicians. Assists in the renewal of ancillary service and member hospital managed care contracts.
 
Position Qualifications:
 
BS degree or equivalent in Business, Health Care Administration, or Managed Care Administration. Five years experience in hospital, physician office, clinical or managed care setting; thorough understanding of clinical operations, health care terminology, and current market conditions.  Three years direct managed care-contracting experience, with emphasis on analyzing and negotiating risk contracts and thorough understanding of managed care financial arrangements and boilerplate negotiations.  Experience with risk contracting preferred.  Good knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred.  Excellent verbal and written communication skills.  Proficiency with Microsoft Office applications.
 
Major Responsibilities:
 
Responds to all inquiries relating to managed care contracts from medical center personnel, physicians and/or physicians office staff. Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system.  Resolves issues relating to health plan credentialing, claims payment, referral management, and various administrative issues.
 
Coordinates with Managed Care Provider Relations staff communication of contractual requirements, updates on policy and operational changes and other contract-related information to various departments within the organization.
 
Coordinates site visits required for credentialing for new and existing programs.
 
Acts as primary liaison with managed care plans in addressing operational issues arising under the managed care contracts. Meets regularly with representatives from the managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and Umass Memorial Medical Group personnel. 
 
Manages contracts to ensure compliance and, with input from the Director, Legal, Finance, and other departments as appropriate, is responsible for renewing and renegotiating contract terms. Assists with financial analysis and negotiation of risk contracts.  Assists in contracting for ancillary services, including home health & hospice and MRI services, and affiliate hospital risk contracts.
 
Helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
 
Complies with established departmental policies, procedures, and objectives.
 
Attends variety of meetings, conferences, seminars as required or directed.
 
Demonstrates use of Quality Improvement in daily operations.
 
Complies with all health and safety regulations and requirements.
 
Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
 
Performs other similar and related duties as required or directed.

Standards of Respect: