What are the responsibilities and job description for the System Manager Managed Care position at Bronson Healthcare?
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Location
BHG Bronson Healthcare Group
Title
System Manager Managed Care
The System Manager for Managed Care is accountable for the development, implementation and ongoing improvement of all Managed Care related activities across the system, including but not limited to all Managed Care activities listed below. The System Manager is also responsible for providing day to day leadership in the coordination of departmental activities, personnel matters pertaining to the employment, training, mentoring, coaching, and staff development. The system manager is responsible for the following : development and management of positive relationships with payors and internal customers; assisting the System Director of Managed care in conducting payor contract review and negotiation activities as needed; designing, monitoring and enhancing organizational processes to minimize non-value add work and maximize efficiency; such as underpayment review processes, departmental dashboards that monitor key performance indicators, settlement prospects or opportunities to affect payor denials, payor performance dashboards, etc.; collaborates with Departmental leaders to obtain input on managed care contracting, credentialing and other activities to improve the service the department provides; leads payor credentialing and delegated credentialing activities, including identification of for improvement in collaboration, process redesign, automation and revenue generation for administrative services; designs implementation of new processes and procedures for payor underpayment reviews, contract modeling, fee schedule analysis and other analytical functions to support the department; ability to function in successfully in an extremely challenging environment and utilizes leadership skills to problem solve and escalate decision-making as appropriate; establishes a course of action for self and others to accomplish specific goals; plans proper assignments, and effective and efficient allocation of resources; and actively attends Management Committee meetings. Employees providing direct patient care must demonstrate competencies specific to the population served.
Bachelor's degree in Healthcare, Business Management or a related field and 3-5 years of previous experience required
Prior management experience in managed care related discipline preferred
- Must possess a demonstrated knowledge of Managed Care, contract negotiation, Revenue Cycle, and process improvement functions.
- Coaching and mentoring staff using tactful and positive feedback to improve performance.
- Diplomatic communication skills with payers when assisting with negotiations.
- Ability to problem-solve with peers and internal departments, and potentially persuade others to see the "bigger Bronson picture" vs. their own specific departmental issue (when appropriate).
- Ability to accept and give constructive feedback for the purpose of developing a high performing team.
- Effectively communicate with physicians and practice leaders to help distill and prioritize payer information that is important and applicable vs. downloading everything payers publish.
Work which produces high levels of mental / visual fatigue, e.g., interactive and repetitive or small detailed work requiring alertness and concentration for sustained periods of time, the operation of and full attention to a personal computer or CRT between 40 and 70 percent of the time.
The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.
o Establish analytics and contract modeling functions and processes within the Managed Care Department that is currently absent
o Formal policies and procedures to document standard work
o Ensure staff adherence to standard work
o Identification of ways to automate processes and eliminate waste and duplication
o Identify and implement an automated contract management system
Shift
First Shift
Time Type
Full time
Scheduled Weekly Hours
Cost Center
1040 Managed Care Contracting (BHG)
Agency Use Policy and Agency Submittal Disclaimer
Bronson Healthcare Group and its affiliates ("Bronson") strictly prohibit the acceptance of unsolicited resumes from individual recruiters or third-party recruiting agencies ("Recruiters") in response to job postings or word of mouth. Unsolicited resumes sent to any employee of Bronson by Recruiters, without both a valid written agreement with Bronson and a direct written request from the Bronson Talent Acquisition Department for a specific job position, will be considered the property of Bronson. Furthermore, no fees will be owed or paid to Recruiters who submit resumes for unsolicited candidates, even if those candidates are hired. This policy applies regardless of whether the Recruiter has a pre-existing agreement with Bronson. Only candidates submitted through a specific written agreement with the Bronson Talent Acquisition Department for a named position are eligible for fee consideration.
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