What are the responsibilities and job description for the Managed Care Contract Manager position at Valley Presbyterian?
Employment Status:
Full Time (72-80 Hours Per Pay Period)
Job Category:
Administrative & Professional
Salary Range (DOE):
$58.84 to $75.33 per hour
Managed Care Contract Manager
About Valley Presbyterian Hospital
Valley Presbyterian Hospital is a beacon of health in the San Fernando Valley, committed to providing outstanding care and improving community health. We are seeking an experienced and detail-oriented Managed Care Contract Manager to join our dedicated team.
JOB SUMMARY:
- Under the direction of the Director of Managed Care, the Contract Manager will manage the compilation, reporting and analysis of data, participate in negotiating, reviewing, and redlining agreements, track all contracts and amendments in the VPH Contract Management System and track all letter of agreements (LOAs) via SmartSheet. This includes, but is not limited to negotiating and papering LOAs, financial models related to managed care contract negotiations, as well as analysis in support of other managed care contracting activities and creating presentations for upper management review. The Contract Manager will conduct quantitative and qualitative analyses on a broad array of issues across functional areas.
EXPERIENCE/QUALIFICATIONS:
- 5-7 years of healthcare experience in Managed Care contracting or as a Financial Analyst or similar position
- Previous Managed Care and capitation-related experience to include understanding the DOFR is highly desirable
- Experience with Letters of Agreement, Hospital, and Ancillary contracting
- Previous contract lifecycle management experience is highly desirable
- Advanced proficiency in MS Office applications, including fluency in the use of advanced Excel formulas, pivot tables, and database queries, Word, and PowerPoint are required
- Familiarity with healthcare data, FinThrive and Meditech strongly preferred
- Strong relationship building and management abilities strongly preferred
- Excellent organizational skills and attention to detail
- Ability to analyze and resolve complex issues, both logical and interpersonal
- Effective verbal and written communication skills and effective presentation skills
- Self-motivated, team player, cooperative, flexible, and creative
EDUCATION:
- Bachelor’s degree in health care, Accounting, or Finance field is preferred
LICENSURES/CERTIFICATION:
- Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment
DUTIES AND RESPONSIBILITIES (These are the essential job functions for this position. The essential functions of this job include but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential function of this job without imposing significant risk of substantial harm to the health or safety of themselves or others):
- Researches and analyzes data from a variety of sources. Prepares and designs analytical reports and prepares complex financial trends and data analysis reports from those sources. Verifies accuracy of data.
- Provides analytical support of capitation financial and statistical data from the external Management Services Organization (MSO).
- Performs contract modeling in FinThrive.
- Ability to identify, manage, and resolve Managed Care operational issues to include escalated issues related to contract negotiations, language review and redlines, renewals, letters of agreements (LOAs), and settlements with payors.
- Works with providers, health plans, IPAs, medical groups and TPA.
- Performs Contract Exclusion audits as applicable.
- Tracks all LOAs on the VPH LOA tracking log and reports weekly status.
- Assists the Director of Managed Care in loading contracts and renewals in the VPH Contract Management System.
- Develops a thorough understanding of the hospital’s capitation and managed care contracts.
- Participates in quarterly joint meetings with IPAs and TPA to improve risk pool performance.
- Reviews claims data to ensure accuracy of adjudication and payment.
- Serves as a key resource and works collaboratively with all stakeholders and the Managed Care Leadership.
- Participates in projects of moderate to complex scope as assigned.
- Completes ad-hoc reports and special project assignments as it relates to Managed Care operations.
WORK ENVIRONMENT:
- Hybrid: part-time in office and part-time working from home.
- Primarily an inside building/office environment, well lighted and ventilated, which may consist of multiple treatment and/or work sites.
- Fast and continuous work pace with variable workload.
- Frequent contact with staff and public under a variety of circumstances. Requires ability to communicate clearly (in English) verbally and in writing for effective communication with other staff members, physicians, vendors, community members, patients and patient families, employees, and applicants of all socio-economic levels from a diverse cultural and ethnic population.
- Subject to many interruptions from multiple calls and inquiries and potentially emotional situations involving accidents, injuries, illness and/or death.
- Handles emergency/crisis situations in accordance with Hospital policy.
- Answers phones or texts.
- Occasional travel may be required.
- Potential risk of exposure to hazards from chemicals (toxic and non-toxic), flammable materials, gas or electrical or radiant energy or equipment with/without moving parts.
Why You'll Love Working Here:
- Supportive Environment: We prioritize teamwork, professional growth, and a positive work culture.
- Impactful Work: Your role will directly contribute to the smooth operation of our organization.
- Professional Development: We offer continuous learning and advancement opportunities to help you grow in your career.
Ready to Elevate Your Career? Join us at Valley Presbyterian Hospital and be a part of a team dedicated to excellence. Apply today to make a difference!
Salary Range: $58.84 to $75.33 per hour
Salary : $59 - $75
