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The AVP of Managed Care will have oversight responsibility for all managed care contracting activities for Surgery Ventures Group. The AVP will collaborate and assist with PCA VPs across the enterprise (e.g. PCHospital and Government AVP and RVP colleagues) on contracting activities with managed care organizations (“MCOs”) and other payers.
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Law degree; at least 8-10 years corporate legal department or law firm experience with a demonstrated background in medical provider contracting and the health care managed care/insurance industry.
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Under the guidance of the Forensic Accounting Manager, will represent OIG for the CMS contractors for the Fee-For-Service (FFS) system and will represent OIG with a delegated responsibility to ensure the CMS managed care contracting process and later implementation is in accordance with program integrity requirements.
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Works closely with clinical departments, hospital and Physician billing, corporate compliance, health information management/coding, managed care contracting and information technology.
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Minimum of fifteen (15) years with biopharmaceutical market access experience, including direct healthcare systems experience in a health plan environment including significant experience in network development, provider/third party payer contracting, value-based reimbursement, and the development of ACOs; in-depth knowledge of managed care regulations; solid understanding of health plan operations and how they think and make decisions.
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5+ years of Managed Care Provider Contracting, Provider Relations or Physician Network development experience. Working knowledge of managed care health plan and provider operations.
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Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Ensures appropriate and accurate information is entered into systems for processing of patient care and reimbursement.
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The ideal candidate will have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products.
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Gathers information on health care providers in the Post Acute Medical service area and forwards to management, including opportunities for contracting with managed care companies and providers.
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One to three years' experience of managed care, quality improvement and/ or provider contracting. One year of case management or managed care environment and/or quality services preferred.
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The CFO is responsible for all financial reporting and the maintenance of the financial health of McLaren Thumb/Caro In addition to managing McLaren Thumb/Caro overall budget, the CFO is also responsible for the system’s managed care contracts, vendor contracts and physician contracting, as well as decision support and the treasury function.
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Knowledge of Federal and State guidelines, managed care contracting, payer filing and appeal limits, and credit and collection policies is also required. We offer a 403(b) retirement plan, tuition reimbursement, child care subsidy reimbursement program, identity theft protection and an employee assistance program.
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Work with the Contracting and Managed Care Officer to manage UHC’s Office of the Pharmacy Affairs (340B OPAIS) profile. The 340B Program Manager is an exempt position and reports to the Contracting and Managed Care Officer.
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Five (5) years of experience working with financial analysis supporting managed care contracting with providers including but not limited to hospitals, professionals ranging from large medical groups to solo practitioners, mental health practitioners, ASCs, skill nursing facilities, renal dialysis facilities, home health and DME. Current working knowledge of all aspects of a provider contract.
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This Director & Assistant General Counsel, Managed Care, Value Based Care, CIN and Malpractice role is primarily responsible for providing legal advice for Novant Health’s commercial managed care contracting, value-based care arrangements and clinically integrated networks.
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