MemorialCare Job - 40958151 | CareerArc
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Company: MemorialCare
Location: Fountain Valley, CA
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

Position Summary:  The Sr. Manager, Contracts Managed Care is responsible for negotiating moderate to complex payer contracts on behalf of the Foundation.  This includes capitation, FFS and other reimbursement methodologies.  Perform and/or arrange for legal language review on all contracts prior to execution. Oversee the implementation of new contracts with appropriate internal departments, including but not limited to:  UM, IT, QM, Billing, Operations and ACO. Works with Billing and other internal departments to resolve moderate to complex payment and utilization issues.  Support and educate other department staff regarding the interpretation and enforcement of the contractual provisions.

Principal Duties and Responsibilities:

  • Negotiate moderate to complex payor contracts for MCMG, GNP and EMG  including HMO, ACO and FFS contracts.    
  • Analyze impact of contract proposals, including changes to DOFR, anticipate utilization trends, etc.
  • Participate in interdepartmental teams requiring Managed Care expertise
  • Resolve moderate to complex billing issues
  • Assist UM with any authorization issues


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