Contract Mgr. II - health plans

Additional Information About the Role BJC HealthCare is seeking a Contracts Manager to assist with healthcare plan negotiations. This role does require quarterly on site meetings. So must be located in MO. or IL. Overview BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes‑Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. The BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value‑based care and payment programs, payor and provider relations, and direct to employer solutions. Preferred Qualifications Role Purpose Manages the negotiation, implementation and ongoing evaluation of designated managed care arrangements. Makes recommendations and takes action to ensure and enhance the success of hospital and physician managed care participation. Responsibilities Manages Single Case Agreements (SCAs) process for new/innovative services to ensure access for patients and secure reimbursement for the hospital, including problem solving critical issues. Responsible for managing the relationship with tier 1 Managed Care Organizations (MCOs), as assigned. This includes facilitating contract negotiations with the MCOs for all components including hospital, physician, ancillary and credentialing agreement in accordance with established guidelines. Maintains close partnership with managed care finance and the value based team to ensure agreements reflect accurate rate, language and other provisions. Includes redline and replacement of BJC accepted language. Independently collaborates with internal stakeholders to ensure strategy is implemented. Participates in key internal meetings with HSOs for the purpose of understanding and sharing information that enhances the development and execution of contract strategies. Collaborates with BJC Legal to review contract language (redlined language and regulatory attachments) and to identify preferred terms and conditions. Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Educates HSOs on contract provisions and collaborates with Provider Relations in addressing operational issues. Minimum Requirements Education Bachelor's Degree Experience 5-10 years Supervisor Experience No Experience Benefits and Legal Statement BJC Total Rewards At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well‑being. Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date Disability insurance* paid for by BJC Annual 4% BJC Automatic Retirement Contribution 401(k) plan with BJC matchli> Tuition Assistance available on first day BJC Institute for Learning and Development Health Care and Dependent Care Flexible Spending Accounts Paid Time Off benefit combines vacation, sick days, holidays and personal time Adoption assistance To learn more, go to our Benefits Summary. *Not all benefits apply to all jobs The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer #J-18808-Ljbffr BJC HealthCare