What are the responsibilities and job description for the Manager, Managed Care Operations Exempt position at CHA Hollywood Presbyterian Medical Center?
MAJOR RESPONSIBILITIES / ESSENTIAL FUNCTIONS
Position Summary :
Reporting to the Vice President of Managed Care, the Managed Care Operations (Senior) Manager will play a key role in overseeing and managing the organization’s managed care operations, and contract administration. The Managed Care Operations (Senior) Manager will work collectively with Revenue Cycle, Data Analytics, Case Management, Operations, Clinical Programs, and Business Development to research, develop, plan and implement managed care operational improvement initiatives.
- Develop and maintain a complete library of payor and vendor contract documentation for each entity including contract summary documents, copies of all fully-executed contracts with related amendments, letters, policies and other operational reference materials
- Identify contracts needed to support managed care business lines, including capitation and new service lines, and support contract negotiations
- Interface with internal departments to ensure operational efficiencies and effective administration of all payor contractual agreements
- Interface with internal departments to ensure the completion and submission of contractual documentation to contracted health plans or IPAs (i.e., provider roster, credentialing information, contracted vendor roster)
- Collaborate with Hospital team and IPA / MSO partners to monitor utilization patterns, identify trends, and implement interventions to drive operational and financial success
- Understand managed care operations and develop process documentation
- Oversee letters of agreement execution and management with non-contracted facilities
- Perform other duties as assigned
JOB QUALIFICATIONS
Minimum Education
Bachelor's degree in business administration, health care administration, public health, or other related fields
Preferred Education
Master’s Degree in business administration, health care administration, or public health preferred but not required
Minimum Work Experience and Qualifications
Preferred Work Experience and Qualifications
Required Licensure, Certification, Registration or Designation
Current Los Angeles County Fire Card required (within 30 days of employment).
ARC (within 30 days of employment).
Shift : Exempt
Hours : Varied
Weekly Hours : 40
Type : Full-Time
FTE : 1
