- At the direction of the SVP, Managed Care and the Director, Managed Care Contracting, negotiates managed care agreements, Letters of Agreement (LOAs), single case agreements (SCAs) and necessary amendments for all managed care payers to meet financial goals and maximize the potential for revenue collection and support operational efficiency. Negotiates contract language and coordinates document review, negotiates delegated credentialing agreements, and obtains contract signatures and timely return of executed contract documents.
- Negotiates and monitors Value-based contracts.
- Supports the review of contract performance and final reconciliation.
- Prepares financial feasibility models for contract renewals to ensure that executed contracts align with department objectives.
- Evaluates financial impact of regulatory changes.
- Supports Operational Teams in the development of business plans and budgets for new services.
- Ensures superior customer satisfaction through purposeful internal and external communication and fosters long term effective business relationships with payer representatives by being accountable, collaborative, and genuine.
- Keeps informed of new managed care reimbursement strategies or methodologies such as bundled payment, pay for performance opportunities or other means of compensation incentives.
- Prepare claims settlement agreements when applicable.
- Performs other duties as assigned
- Strong knowledge of hospital and physician reimbursement methodologies (i.e., DRG, per diem, fee schedule, APC).
- Working knowledge of billing/coding terminology (i.e., ICD-10, CPT, Revenue codes); Procedural knowledge of hospital and physician practice accounts receivable management
- In-depth knowledge of payor contracting and negotiation
- Working knowledge of privileging, credentialing, provider enrollment and managed care contracting requirements, practices, and industry standards.
- Ability to be a liaison between Managed Care, Revenue Cycle and Operations.
- Ability to work collaboratively with Revenue Cycle Management (RCM) to address underpayments and incorporate lessons learned from vendors and colleagues into contract negotiation strategies.
- Ability to utilize assessment and communication tools to monitor the performance of agreements and other information critical to the organization.
- Ability to make a significant contribution to the organization's overall effectiveness.
- Must be a team player who strives for excellence and is dedicated to outstanding customer service.
- A mature approach to problem-solving for all types of issues
- Extensive experience with Microsoft Office - Excel, Access, Word and Power Point
-
Director, Managed Care Contracting
3 weeks ago
OU Health Edmond, United StatesPosition Title: · Director, Managed Care Contracting · Department: · Financial Services · Job Description: · Position Title: Dir Managed Care Contracting · General Description: The Director, Managed Care Contracting has responsibility for negotiating and managing managed ca ...
-
Intensive Care Unit RN Travel Contract
3 days ago
RTG Medical-Nursing Edmond, OK, United StatesRTG Medical-Nursing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Edmond, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours · ~ Employment Type: Travel · RTG Medical Job ID #ndzua. Pay package is based on 12 hour shifts ...
-
Intensive Care Unit RN Travel Contract in
3 days ago
Talent4Health Edmond, OK, United StatesTalent4Health is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Edmond, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours, days · ~ Employment Type: Travel · Knowledge of professional nursing theory, practices, techniques an ...
-
RPh on the Go Edmond, United StatesJob Description · Job DescriptionMinimum 1+ years pharmacy experience required. · Description: · Join our team at a Long Term Care,Mail Order facility in Oklahoma City, OK that promises invaluable experience in pharmacy order entry. This opportunity provides exposure to a fast-pa ...
-
Director OF Managed Care Contracting
16 hours ago
Insight Global Oklahoma City, United StatesA university hospital system is looking for a Director of Managed Care Contracting in the Oklahoma City area. This person will be responsible for the day-to-day operations of the Managed Care Department. This person will be responsible for negotiating and managing managed care ag ...
-
Primary Care Contract Assignment in Oklahoma
2 weeks ago
Medicus Healthcare Solutions Oklahoma, United StatesMedicus is partnering with a federal facility in central Oklahoma with an opening for a Primary Care Physician to provide locum coverage. · Schedule: 8-hour day shifts · Comprehensive medical malpractice coverage. Travel Planner to book all arrangements. Credentialing Contact t ...
-
Intensive Care Unit RN Travel Contract
1 week ago
PHP Oklahoma City, OK, United States TemporaryPHP is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Oklahoma City, Oklahoma. · Job Description & Requirements · ~ Specialty: PACU - Post Anesthesia Care · ~ Discipline: RN · ~ Start Date: 05/19/2024 · ~ Duration: 13 weeks · ~36 hours per ...
-
Intensive Care Unit RN Travel Contract in
1 week ago
Gifted Healthcare Oklahoma City, OK, United StatesGifted Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Oklahoma City, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours, nights · ~ Employment Type: Travel · Gifted Healthcare has travel, local and PRN/Per Diem ...
-
Intensive Care Unit RN Travel Contract in
1 week ago
Talent4health Oklahoma City, OK, United StatesTalent4Health is seeking a travel nurse RN Neuro ICU for a travel nursing job in Oklahoma City, Oklahoma. · Neuro ICU · ~ Shift: 12 hours, nights · ~ Employment Type: Travel · -Graduate from an accredited school of nursing. - Bachelor of Science (or higher) in Nursing Board A ...
-
Care unit registered nurse travel contract
4 weeks ago
Trusted Health Oklahoma City, OK, United StatesTrusted is seeking an experienced nurse for this exciting travel nursing assignment. Trusted has streamlined the travel nursing experience by enabling nurses to apply directly to jobs without the need for recruiters. Join the thousands of nurses across the country who have alread ...
-
Intensive Care Unit RN Travel Contract
1 week ago
RTG Medical-Nursing Oklahoma City, OK, United StatesRTG Medical-Nursing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Oklahoma City, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours · ~ Employment Type: Travel · RTG Medical Job ID #5rv9z. Pay package is based on 12 hour ...
-
Intensive Care Unit RN Travel Contract in
3 days ago
Talent4Health Oklahoma City, OK, United StatesTalent4Health is seeking a travel nurse RN Neuro ICU for a travel nursing job in Oklahoma City, Oklahoma. · Neuro ICU · ~ Shift: 12 hours, nights · ~ Employment Type: Travel · Required Documents: · A leader and innovator, offering comprehensive talent solutions for the health ...
-
Intensive Care Unit RN Travel Contract
6 days ago
RTG Medical-Nursing Oklahoma City, OK, United StatesRTG Medical-Nursing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Oklahoma City, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours · ~ Employment Type: Travel · RTG Medical Job ID #bxspf. Pay package is based on 12 hour ...
-
Intensive Care Unit RN Travel Contract
3 days ago
RTG Medical-Nursing Oklahoma City, OK, United StatesRTG Medical-Nursing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Oklahoma City, Oklahoma. · Specialty: ICU - Intensive Care Unit · ~ Shift: 12 hours · ~ Employment Type: Travel · RTG Medical Job ID #v98ds. Pay package is based on 12 hour ...
-
Intensive Care Unit RN Travel Contract
1 day ago
Medical Solutions Oklahoma City, OK, United States44 in non-taxable per diem (amount subject to eligibility & seasonal/annual adjustment) · A facility in Oklahoma City, OK, is currently hiring a RN (Registered Nurse) to work in ICU (Intensive Care Unit). Nurses and allied healthcare professionals are in high demand nationwide, a ...
-
Risk Management Nurse/Quality Manager
8 hours ago
Bridges Health Edmond, OK, United States Full timeThis Job is being Advertised for our Edmond, OK Location. In nursing, there is a growing need to go beyond bedside care and to look more deeply at systemic opportunities to improve outcomes and quality of life. If you are a Nurse that is passionate about care but equally passion ...
-
Medical Assistant CTA
2 weeks ago
Actalent Oklahoma City, United States Full timeHIRING: Hospital Nurse Assistant / Patient Care Techs in Oklahoma City for one of the top hospitals in the state · Interested in an opportunity with great pay and exceptional career advancement? Apply today · Job Description: · Job Duties - Assist with vitals, catheter care, char ...
-
cna
2 weeks ago
Actalent Oklahoma City, United States Full time**HOSPITAL** NURSE ASSISTANT / PATIENT CARE TECH OPPORTUNITY · Actalent Healthcare is hiring for Patient Care Techs for a large hospital in Oklahoma City · Job Description: · Obtain vital signs, blood sugar levels, catheter care, pass trays, charting into EPIC, and assisting pati ...
-
Acute Dialysis Registered Nurse
1 week ago
Fresenius Medical Care Oklahoma City, United States Full timePURPOSE AND SCOPE: · The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. The CAP RN 1 is accountable and responsible for the provision and coordination of clinically competent care inclu ...
-
Travel Nurse RN
1 week ago
MedPro Healthcare Staffing Edmond, OK, United StatesMedPro Healthcare Staffing is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Edmond, Oklahoma. · Job Description & Requirements · Specialty: PACU - Post Anesthesia Care · Discipline: RN · Start Date: 06/17/2024 · Duration: 13 weeks · 40 hours pe ...
Manager, Managed Care Contracting - Edmond, United States - OU Health
Description
Position Title:Manager, Managed Care Contracting
Department:
Financial Services
Job Description:
General Description: The Manager, Managed Care Contracting is responsible for negotiation and implementation of Commercial, Government payer and Value-based contracting. Critical responsibilities of this position encompass contract administration including maintenance, contract renewals processing and renegotiations. Under the direction of the SVP, Managed Care and the Director, Managed Care Contracting, the Manager, Managed Care Contracting initiates contract-related financial modeling and analysis and implements contracting initiatives to achieve organization and department goals, and monitors payer activity to ensure their compliance with contractual and regulatory terms and provisions. The Manager, Managed Care Contracting is expected to demonstrate, through plans and actions, a consistent standard of excellence to which all departmental work is expected to conform. The standard should be based on establishment and maintenance of a constancy of purpose, focus on continuous improvement with the Manager's area of influence and on delivery of the highest degree of quality service possible. Position could be considered for hybrid work with 3 days in office per week.
Essential Responsibilities:
Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
Education: Bachelor's degree in health administration, Business, Finance, or related field is required.
Experience: 3 - 5 years of professional experience within an Academic Medical Center, Multi-hospital Health System or Managed Care Organization (MCO) company, with demonstrated experience in healthcare analytics and medical economic modeling.
License(s)/Certification(s)/Registration(s) Required: None
Knowledge, Skills, and Abilities:
Current OU Health Employees - Please click HERE to login.
OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.