At Stony Brook Medicine, as a Managed Care Contract Manager , you will work under the oversight of the Director of Managed Care Contracting and join a team of professionals representing Stony Brook Medicine and its Clinically Integrated Network. As a member of this team, you will play a key role in strategy, development, implementation, and ongoing management and monitoring of managed care contracts, including managed care quality incentive contracts. You will participate in the development of an overall strategy for managed care contract activities and rate negotiations
Duties of a Managed Care Contract Manager may include the following but are not limited to:
Participate in the development and administration of managed care contracts, including managed care quality incentive contracts in a manner consistent with Stony Brook Medicine's strategic approach to managed care payer contracting.
Evaluate rate proposals and changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract.
Participate in the development of management reporting systems to measure, track and monitor utilization and financial performance of managed care contracts and managed care quality incentive contracts. Communicate results with key stakeholders.
Assist internal clients with the resolution of payer issues. Coordinate meetings with contracted payers to address operational and/or payment issues and recommend changes to internal processes as needed.
Establish and maintain positive working relationships with both internal and external customers to improve quality outcomes while optimizing reimbursement or by lowering costs.
Assist in the conduct of special hospital and physician contract negotiations (single case agreements).
Upon request from managed care payer, complete facility credentialing applications.
Interpret information contained in MCO or payor provider manual, newsletters and bulletins and communicate such policy or procedure to applicable SBM team members.
Facilitate internal quality incentive program/value based agreement workgroup(s) that shall monitor, analyze and manage contract performance, requirements and reconciliation. Meets regularly with payer representatives and is deeply knowledgeable of all contractual agreements. Works closely with the clinical leadership team to achieve the organization's goal to support and move toward value through innovative value based contracting.
Working in conjunction with key stakeholders, negotiate quality incentive program/value based agreement's financial risk terms. Develop financial risk models to analyze payer proposals, shared savings/shared risk, capitation, global bundled pricing and percentage of premium contracts. Assess risk exposure, potential upside and downside opportunities and coordinate feedback from key stakeholders.
Responsible for timely renewal of all payer contracts to ensure there is no delay in reimbursements
Oversees reimbursement from all payers for quality incentive/value based agreements and quality incentive payments.
At least 2 years' experience with managed care contract negotiations and managed care contract management.
Demonstrate project management skills and be proficient in database management.
Demonstrate background in healthcare policy and management.
Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities.
Ability to follow, read and interpret managed care payer contracts and experience with leading quality program/value based reimbursement initiatives.
Proficient in the use of Microsoft Office-Word, Excel, PowerPoint and Google software.
Expertise with various reimbursement management areas such as patient billing, collections (posting and credit balance), resolution and other basic reimbursement functions.
MBA, MHP, MPA or equivalent advanced degree.
Experience with either managed care organizations, payers or health care providers, particularly academic medical centers.
Expertise with NCQA's HEDIS and CAHPS Measures and CMS Value Based Care Programs (i.e., BPCI, HACRP, HRRP, VBP, MIPS, etc.).
Experience in the development, implementation and administration of managed care contracts, including managed care quality incentive contracts.
Special Notes : Resume/CV and cover letter should be included with the online application.
In accordance with the New York State Department of Health (DOH) regulation that all hospitals and nursing homes "continuously require all personnel to be fully vaccinated against COVID-19," Candidates who are not already partially vaccinated must obtain the first dose of the vaccine within three (3) calendar days of acceptance of conditional job offer and must obtain any subsequent doses in accordance with the vaccine protocol, including booster vaccines. Candidates who are partially vaccinated, but not yet fully vaccinated, must complete their vaccination series within three (3) calendar days of job offer or in accordance with vaccine manufacture protocol, whichever comes later.
The regulation also includes those who may be affiliated with or interact with employees of a hospital or nursing home. The regulation allows for limited exemptions with reasonable accommodations, consistent with applicable law.
Posting Overview : This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions maybe subject to changes in pass days and shifts as necessary.
This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Prior to start date, the selected candidate must meet the following requirements:
Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
Complete electronic reference check with a minimum of three (3) professional references.
Successfully complete a 5 panel drug screen*
Successfully complete a Background Check investigation.
Provide a copy of any required New York State license(s)/certificate(s).
Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
*The hiring department will be responsible for any fee incurred for examination .
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.
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Job Number: 2201845
Official Job Title: TH Senior Staff Assistant
Job Field: Administrative & Professional (non-Clinical)
Primary Location: US-NY-East Setauket
Department/Hiring Area: Medical Center Managed Care
Schedule: Full-time Shift :Day Shift Shift Hours: 8:30 AM - 5:00 PM Pass Days: Sat, Sun
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