Contracts Manager

Location
Silver Spring, Maryland-Silver Spring
Posted
Mar 02, 2021
Closes
Apr 06, 2021
Ref
210000GP
Function
Administrative
Industry
Healthcare
Hours
Contract
Develop and maintain relationships with managed care payers. Negotiate and renegotiate facility and professional managed care contracts. Assess and monitor utilization and payments for designated managed care payers

Qualifications

Minimum Education
Bachelor's Degree - Business, health care or related field (Required)

Minimum Work Experience
5 years - Related and progressive experience (Required)
Direct contracting experience (Preferred)

Functional Accountabilities

Data Analysis and Evaluation to Support Contracting
1. Demonstrate understanding of data sets and billing protocols required for effective evaluation of utilization and financial information.
2. Evaluate financial and utilization information for assigned payers.
3. Work with Executive Director and analyst to evaluate alternative financial provisions during contract negotiation to optimize financial performance.
4. Able to independently utilize analysis tools for data evaluation.

Managed Care Contract Negotiations
1. Negotiate new/renegotiate existing hospital and physician contracts in a timely manner.
2. Negotiate financial terms that are market competitive and support organization's financial requirements.
3. Negotiate contract provisions to enhance operational performance and minimize administrative/payment problems.
4. Develop recommendations for achieving desired financial and operational parameters.

Knowledge and Application of Contract Provisions
1. Understand all provisions of existing contracts with assigned payers.
2. Able to effectively apply contract provisions as appropriate when operational issues arise.
3. Develop and document suggested modifications to address desirable improvements for contract amendments or renegotiations.
4. Expand general understanding of implications of contract provisions and related laws to promote more effective contracts.

Contract Administration and Management
1. Monitor data to identify payment patterns that are not consistent with contract provisions.
2. Troubleshoot operational issues and participate in developing and implementing resolution as appropriate.
3. Work constructively with payers to facilitate resolution of operational/payment issues.

Internal Communication
1. Communicate new or revised contract arrangements to internal personnel, including business operations, decision support, CRM, and others as required.
2. Work effectively with internal staff to define and document operational/payment issues.
3. Coordinate internal work groups/action plans as appropriate to ensure effective contract administration.
4. Maintain regular communications with personnel in assigned clinical centers to ensure managed care department has current information regarding initiatives and/or issues of that clinical area.

Safety
1. Speak up when team members appear to exhibit unsafe behavior or performance
2. Continuously validate and verify information needed for decision making or documentation
3. Stop in the face of uncertainty and takes time to resolve the situation
4. Demonstrate accurate, clear and timely verbal and written communication
5. Actively promote safety for patients, families, visitors and co-workers
6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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