Managed Care Contracting Manager - Irvine, CA, US
1 week ago
+ Comprehensive proactive reactive wellness resilience resources exclusively public safety professionals
Job summary
The Managed Care Contracting Manager exercises independent judgment discretion managing First Responder Health payer contracting operations strategic enrollment portfolio This role independently analyzes complex payer requirements develops implements contracting strategies makes authoritative determinations enrollment priorities credentialing approaches exercises significant autonomy resolving payer related operational issues directly impact organizational revenue compliance.
+ Independent evaluate prioritize payer enrollment opportunities based strategic value revenue potential operational capacity market conditions make authoritative recommendations Controller CEO payers pursue maintain terminate Exercise independent judgment analyzing payer contract terms fee schedules requirements identify favorable unfavorable provisions recommend negotiation strategies contract modifications Develop implement comprehensive enrollment strategies new service lines facilities determining optimal timing sequencing resource allocation minimal oversight Make independent determinations regarding payer credentialing approaches documentation requirements compliance strategies complex multi entity healthcare organizations. Exercise discretion interpreting complex payer contract terms policy updates regulatory requirements independently determine operational implications necessary organizational responses Manage renewals contracts including evaluating performance identifying concerns opportunities making recommendations renewal terms renegotiation priorities Establish maintain systems for contract documentation version control access exercise judgment determining what information requires distribution whom Independently assess compliance risks related payer requirements enrollment status determine implement corrective actions mitigate identified risks.
Job description
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