Manager, Managed Care Contracts
Responsible for increasing patient volume by identifying and pursuing new sources of business, evaluating and negotiating new and existing contractual arrangements, facilitating development of internal systems that are customer oriented and market sensitive, and building and maintaining ongoing relationships with payers and other customers.
- Identifies and pursues new payers and other sources of potential business. Negotiates all aspects of managed care contracts.
- Implements new payer contracts including organizing interface meetings, developing policies and procedures and internal communications.
- Increases patient access to City of Hope by negotiating one time patient specific agreements on behalf of City of Hope Medical Foundation and City of Hope National Medical Center.
- Educates internal personnel on the reimbursement and operational terms of managed care contracts.
- Provides feedback to internal staff regarding customer perceptions and needs. Facilitates internal meetings and participates on work teams.. Serves as a resource for Patient Financial Services to resolve high dollar and/or habitual claims underpayments for City of Hope Medical Foundation and City of Hope National Medical Center.
- Serves as a resource to navigate HMO patients through authorization and health plan appeal processes; as well as providing guidance to internal constituents on how to operationally work with medical groups and IPAs.
- Develops and enhances existing payer relationships through responsive problem solving and servicing. Constantly seeks ways to improve service and overall value generated by City of Hope.
- Works with internal constituencies to insure that the managed care contracts meet the needs of the City of Hope Medical Foundation and City of Hope Medical Center from legal, financial, and operational perspectives.
- Maintains professional growth and development and keeps abreast of latest trends in area of expertise.
- Attends meetings as required and participates on committees as directed.
- Maintains a positive image when dealing with department personnel and other City of Hope employees.
- Bachelor’s Degree in Business Administration, Health Care Administration or related field. Master’s degree is preferred. Experience may substitute for minimum education requirements
- 5-7 years managed care contracting experience in hospital, medical group, health plan, or Independent Practice Association (IPA). Higher level of education may substitute for the combination of minimum education and years of experience.
- Extensive knowledge of Managed Care
- Financial acumen and strong skills in financial analysis
- Demonstrated strong written and verbal communication skills
- Ability to plan and carry out responsibilities with minimum supervision
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 4000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s 20 leading cancer centers that develops and institutes standards of care for cancer treatment.
City of Hope strongly supports and values the uniqueness of all individuals and promotes a work environment where diversity is embraced. City of Hope is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
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