Jobs
>
Detroit

    Director, Managed Care Operations, Michigan - Detroit, United States - Tenet Healthcare Corporation

    Default job background
    Description

    This position will focus on the development and growth of strategic partnerships with community physicians, FQHCs and local Managed Medicaid Plans.

    This position will also work on identifying, managing, and resolving managed care operational issues as well as assisting in Managed Care contracting and negotiations.

    This position will interact externally with local managed care payors, FQHCs, POs and internally with constituents, including but not limited to:

    other Managed Care Contracting team members; Conifer for Revenue Cycle matters; USPI Managed Care; Market Operators and Finance team members; Legal; and Managed Care Finance.

    This position will also lead the resolution of escalated managed care operational issues and identify areas for operational improvement and implement related programs.


    Essential job responsibilities include:

    • Lead a successful conversion of the Physician Organization (PO) that the DMC Medical Group providers are currently enrolled in.
    • Work in collaboration with the DMC Medical Group Physicians and Leadership to optimize performance for key quality levers to maximize reimbursement opportunities under P4P programs.
    • Where appropriate, strategize where DMC hospital-based providers (University Pediatricians or Wayne Health) might have value-based opportunities that could further quality initiatives and support cost reduction in the DMC Market.
    • Lead and ensure DMC Medical Group maximizes funding opportunities under the BCBS PGIP program.
    • Lead hospital P4P quality improvement initiatives to maximize quality incentive payments.
    • Develop and expand relationships with FQHCs and community PCPs to establish care pathways with the DMC and DMC specialists.
    • In coordination with other Tenet Managed Care team members, function as the DMC liaison for provider relations, particularly with local Managed Medicaid and Medicare Advantage payers, to establish and maximize strategic alignment.
    • Partner with Conifer, Tenet Managed Care and DMC reimbursement team to enhance collections under our contracts.
    • Develop strategies for collaboration between DMC Medical Group Physicians and FQHCs, POs, and local Managed Medicaid plans for targeted service line growth.
    • In coordination with other Tenet Managed Care team members, coordinate collaborations with DMC and targeted national Michigan Medicaid payers to ensure DMC's network prominence in the new Medicaid environment, including implementing RFP commitments with certain Michigan Medicaid payers.

    Required:

    • Bachelor's degree.
    • 5+ years of relevant experience.
    • Strong organizational and communication skills and ability to successfully navigate and add value with a collaborative personality in a highly matrixed organization.
    • Strong relationships with people in the industry.
    • Ability to travel up to 10% required. Selected candidates will be required to pass Motor Vehicle Record check.

    Preferred:

    • Masters or other advanced degree.
    Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce.

    If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.

    If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

    #LI-JR1


  • Gold Standard Staffing Detroit, United States

    Job Description · Job DescriptionSee all of our positions at · Production Operator · Detroit, Michigan 48209 · $20+ Based upon experience · Shifts: Rotating Swing · Job Description: · Perform manual labor in manufacturing environments such as assembling, packaging, etc. May also ...


  • Sachse Construction Hamtramck, United States

    Added - 07/26/21 Estimating Assistant Retail Operations Detroit, Michigan | Full-Time **Related Retail Operations Jobs** · Detroit , Michigan United States Detroit Detroit, Michigan **Job Description** · You will be responsible for supporting the Estimators with a large variety ...


  • Gold Standard Staffing New Boston, United States

    Job Description · Job DescriptionSee all of our positions at · Position Overview · Serve as material handler in forge shop. Transports racks of bar steel, scrap metal hoppers, dies, air rams, hot boxes, ect. Co-ordinates movement of materials with forge shop manager and shippin ...


  • DMC Children's Hospital of Michigan Detroit, United States Respiratory Therapy

    Children's Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including P ...


  • Tenet Healthcare Detroit, United States Full time

    Speech Language Audio Clinical Fellow FT Days Description : DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, str ...


  • Tenet Healthcare Detroit, United States

    Patient Sitter Per Diem Days Description : DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, ortho ...

  • DMC Rehabilitation Institute of Michigan

    Registered Nurse

    5 days ago


    DMC Rehabilitation Institute of Michigan Detroit, MI, United States

    **Up to $10,000 Sign on Bonus, based on amount of relevant experience** · Unit Specializes in: Traumatic Brain Injury/Stroke · Specialized Equipment: Beds/wound vacs · RN's involved in goal setting and achieving positive outcomes and increased LOS increasing patient/RN relati ...


  • Tenet Healthcare Detroit, United States Full time

    Physical Therapist for Pelvic Floor Specialty RIM Main Campus - FT Days Sign on Bonus available Description : **$10,000 Sign on Bonus, with required amount of relevant experience** · DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing ...


  • DMC Children's Hospital of Michigan Detroit, MI, United States

    Unit Specializes in: Operating Room Cases · On call Requirements · Children's Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed spec ...


  • DMC Children's Hospital of Michigan Detroit, United States

    **Up to $25,000 Sign on Bonus, based on relevant experience** · Unit Specializes in: · Operating Room Cases · On call Requirements · Children's Hospital of Michigan · is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, rec ...


  • DMC Rehabilitation Institute of Michigan Detroit, United States

    DMC Rehabilitation Institute of Michigan · is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics and catastrophic injury care. The In ...


  • DMC Rehabilitation Institute of Michigan Detroit, United States

    DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics and catastrophic injury care. The Inst ...


  • Tenet Healthcare Detroit, United States Full time

    Licensed Practical Nurse Rehab FT Days Sign on Bonus available Description : ***Up to $5,000 Sign-On bonus based on experience*** · DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is kn ...


  • Tenet Healthcare Detroit, United States Full time

    Licensed Practical Nurse SCI FT Nights Sign on Bonus available Description : **$5,000 Sign on Bonus, with required amount of relevant experience** · DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and re ...

  • DMC Rehabilitation Institute of Michigan

    Registered Nurse

    5 days ago


    DMC Rehabilitation Institute of Michigan Detroit, United States

    **Up to $25,000 Sign on Bonus, based on relevant experience** · DMC Rehabilitation Institute of Michigan · is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, s ...


  • DMC Children's Hospital of Michigan Detroit, United States

    Unit Specializes in: · Operating Room Cases · On call Requirements · Children's Hospital of Michigan · is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed spec ...


  • Tenet Healthcare Detroit, United States

    RN Spinal Cord Injury Contingent Nights Description : DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amp ...

  • DMC Rehabilitation Institute of Michigan

    Registered Nurse

    1 week ago


    DMC Rehabilitation Institute of Michigan Detroit, MI, United States

    **Up to $15,000 Sign on Bonus, based on amount of relevant experience** · Unit Specializes in: Amputee/Vascular/ Cardiology/Stroke · Specialized Equipment: LVAD's, wound vacs/beds · In rehab setting pt turn over is quicker then the other two units. Patients have increased med ...


  • Tenet Healthcare Detroit, United States

    RN Surgical Per Diem Rotating Shift (Experienced OR Nurses Only) Description : Unit Specializes in: Operating Room Cases · On call Requirements · Children's Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, ...


  • DMC Children's Hospital of Michigan Detroit, MI, United States

    Children's Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including ...