Manager Contract-Managed Care

Requisition ID
2017-7945
Category
Management / Leadership
Facility
Community Medical Centers - Corporate Offices (CMC)
US-CA-Fresno
Posted Date
11/21/2017

Overview

The Manager Contract Managed Care is a vital member of our mission.

In this role you will be responsible for overseeing and supporting, at various levels of responsibility, contracting activities (e.g. physician and ancillary contracts) and contract management functions for CMC and Santé Health System (SHS) clients supported by the Managed Care department. Oversees assigned staff, ensuring effective communication, staff development, budget support, fiscal control, interdepartmental relations and personnel management.  

 

Why are we the “Employer of first choice”?

We provide a world of opportunity for professional growth and personal advancement by making the health and financial security of our employee’s a top priority. We embrace our responsibility to the people who make us the largest private employer in the central San Joaquin Valley by offering comprehensive and affordable medical benefits as part of your employment with CMC.  We value giving you a choice in your health coverage by providing three medical plan options.  You will also be offered prescription drug, dental and vision coverage, paid time off, flexible spending accounts, life and disability insurance, discounts on many goods and services, and an employer matched Tax Sheltered Annuity Plan (403(b)).

Our team members enjoy additional benefits such as: education reimbursement, an employee gym, concierge service, and award winning cuisine. 

Based in Fresno, California, we are a multi-specialty healthcare system comprised of four hospitals; Community Regional Medical Center, Clovis Community Medical Center, Fresno Heart & Surgical Hospital, Community Behavioral Health Center. Additionally, our system includes other health care facilities and a physician residency program in conjunction with the University of California, San Francisco. Our primary service area is 15,000-square-miles, and we're home to the only combined, burn and Level 1 trauma center between Los Angeles and Sacramento. 

Community Medical Centers is an Equal Opportunity, Affirmative Action employer fully dedicated to achieving a diverse staff. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, veteran status, disability status, sexual orientation, gender identity, or any other protected status.

If you are looking to make a difference and value a purposeful, lasting career, we provide that in our 120 year old hospital system! For more information on why you should choose Community please click the link:https://www.communitymedical.org/

Responsibilities

  • Provides direction and supervision to assigned department staff in areas of contracting, contract management and provider relations.
  • Contracting:
    1. Responsible for evaluating and negotiating contracts with health plans on behalf of the Community Foundation Medical Group (CFMG) and practice management clients.
    2. Provides contracting support for Community Care Health Plan (CCHP).
    3. Coordinates the transitioning/onboarding of new providers into CFMG by working closely with health plan payors and the operations team.
    4. Responsible for network development and network management functions for SCP, CFMG, ACO, and practice management clients as assigned.
  • Contract Management:
    1. Accountable for the accurate maintenance and management of provider databases (including the MSO and SHS Roster Program) for regular and specialty contracting such as CFMG and ACOs. Responsible for required updates and plan reporting.
    2. Acts as a liaison with Patient Financial Services, physician offices and health plans to resolve contractual issues and ensure compliance with negotiated contractual terms.
    3. Communicates with operations regarding contract modifications impacting operations.
    4. Performs in-services for new and modified contracts.
  • Provider Relations:
    1. Responsible for building and maintaining productive and positive relationships with physicians, office staff, facilities, brokers and health plans.
    2. Works with internal and external customers to ensure contract compliance and to strengthen business relationships.
  • Staff Management:
    1. Assigns, directs and reviews the work of subordinates, manages staffing and scheduling functions to achieve department objectives.
    2. Administers the HR processes for assigned staff: participates in the hiring and interviewing process; completes time and attendance; coordinates the performance evaluation process to ensure consistent evaluations within scheduled time frames; performs  disciplinary processes in service area and advises the Director of all final written warnings and terminations.
  • Performs other duties as assigned.

Qualifications

Minimum required:

Bachelor’s degree in Healthcare, Business Administration, or related field and three years experience in managed care, physician office or health plan environments. Seven years relevant experience may be substituted in lieu of education.

Preferred: 

Bachelor’s degree in Healthcare, Business Administration, or related field and three years experience in managed care, physician office or health plan environments. Seven years relevant experience may be substituted in lieu of education.                                                                          

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed