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Contract Manager - Managed CareJob ID 148128 Date posted 05/17/2018
Position Summary: The Contract Manager (Managed Care) is responsible for participating in the negotiation and execution of managed care contracts between Lahey Clinical Performance Network, other Lahey entities and affiliated providers and various managed care payers. Manages the contract renewal process. Serves as the coordinator of contract language review/edit process in contract negotiation and coordinates completion and submission of payers requests for information for Center of Excellence status as well as hospital re-credentialing applications. Serves as a key contact for contract issues with the payers and operational staff. Supports the negotiation of Behavioral Health and/or International Department payer contracts and serves asa contracting liaison to the Transplant Team. Maintains contract database and Contracting Department file of original executed contract documents.
Essential Duties & Responsibilities including but not limited to:
1) Participates in analyses of managed care proposals and participates in negotiation of financial terms with payers
2) Specifically oversees the portion of execution of managed care contracts related to review of contract language with pertinent staff and legal counsel. Coordinates the contract language review/edit process and negotiates modifications or terms as necessary.
3) Serves as a key liaison to payers representing Lahey Health and educates them re: Lahey Healths organizational and legal structure.
4) Develops communication and communicates with appropriate personnel regarding new contracts and any modifications or renewals of contract terms. Maintains working relationships with operational staff while supporting them in contract terms issue resolution with the payers.
5) Develops and maintains contract database for tracking and managing contract cycle.
6) Manages or participates in contract renewal process.
7) Works with staff, group practice medical leadership, and administration to negotiate arrangements under risk contracts with non-Lahey providers and Lahey Health affiliated providers.
8) Develops and maintains reports and completes analyses as necessary. Responsible for the filing/update of Contracting file of original contract documents.
9) Provides staff support to Vice President, Contracting and Director, Contracting for projects and committees.
10) Negotiates directly with non-contracted payers for specific individual patient services to be provided by Lahey Health affiliated providers.
11) Supports Lahey Health Systems Behavorial Health and/or International Department in negotiating financial and contract terms with various payers and in negotiating patient specific agreements when necessary.
12) As applicable supervises the completion and submission of facility re-credentialing applications from various payers as required.
13) As applicable, coordinates the completion and submission of Requests for Information to apply for/maintain Lahey Health facilities and programs status as Centers of Excellence with various payers
14) Functions as Contracting liaison for Behavioral Health, International and/or transplant services team
15) Performs other duties as assigned, or directed, to ensure the smooth operation of the department including direct communication with patients and payers related to contracts
Excellent communication, negotiation and organizational skills; demonstrated ability to close business deals. Must be able to work independently.
Education: Bachelors Degree in Health Administration, Business Administration or Public Health required or equivalent education and experience. Masters Degree preferred.
Skills, Knowledge & Abilities: In the absence of any of these skills, demonstrates the ability to be thoroughly trained to meet organizational standards.
Experience: Previous experience in negotiating managed care contracts from either the payer, plan or provider perspective with a minimum 3-5 years experience in a managed care setting and 2-3 years in behavioral health care setting required. International experience preferred.
About Lahey Health
The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
How To Apply
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