Manager Managed Care Contracts

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2300 clinics care sites and 137 hospital-based locations in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157000 employees 45000 nurses and 25000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care community benefits and unreimbursed government programs. Together with our patients physicians partners and communities we are creating a more just equitable and innovative healthcare delivery system.

Strongly prefer candidates with California managed care experience and in the West Coast or Mtn time zone. This is a remote position with a preference for someone to be located in California. 

Implements managed care policies, goals and objectives related to contract language and reimbursement, negotiation strategy, and national payer relationship management.  This position, in coordination with the PSR National Payers Team, supports negotiations with a wide-variety of fee-for-service and value-based contracts across all of CommonSpirit Health’s geographies, focusing on the largest national health insurers and their numerous business lines (e.g. commercial, government, and service-line specific).  The Manager, National Payers, collects and communicates Division-level insight and strategic knowledge to/from the PSR National Payers teams, the PSR Growth & Innovation team, and a host of other key departments across the enterprise (finance, strategy, population health, etc.). This position is support PSR functions, which are essential to CommonSpirit Health’s financial performance, and has significant impact on the long-term strategic trajectory of the organization. High expectations exist to secure optimal fee for service and value-based reimbursement, protect the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations, and strengthen CommonSpirit Health’s relationships with all National Payers.

• Reviews contract proposals, language and rate sheets to ensure accuracy, completeness and in compliance with CommonSpirit Health standards and guidelines.
• Negotiates National Payer single case agreements and other assigned agreements, at the direction of the senior leadership.
• Recommends corrections, changes and any language opportunities in contract documents to System Director and System Vice President.
• Maintains and make readily available national library of best-practice contract language, rate structure, and value-based agreements of CSH’s National Payers.
• Lead communication plans around official correspondence as issues arise with national payer policy updates or compliance with CSH agreements.
• Monitor national contract terms, termination dates, and rate update deadlines to assure proper and timely notification achieved in compliance with project plan and strategy.
• Ensure all amendments, letters of agreement (LOA), memorandum of understanding (MOU) and other contract documents are signed by the appropriate parties, and provide the fully executed contract documents to the Contract Administration team.
• Assist in developing tools/updates for communicating and operationalizing contract terms, amendments, and policy terms. Assist System Director with updating project plan documents and communications plans.
• Maintain National Payer knowledge base to include financial statements/reports, news articles and other information.
• Provide support and contracting accountability for negotiation to include hospital, physician, and ancillary services.

Required Education and Experience

• Bachelor’s Degree – equivalent experience and/or education may be considered in lieu of degree
• Minimum of five (5) years of experience in Healthcare Finance and/or health care contracting

Minimum Skills, Abilities, Knowledge and Training

• Ability to establish, build, and maintain positive, strategic interactions and relationships with leaders across the ministry
• Set and maintain multiple priorities in an environment with shifting priorities, while providing accurate deliverables in a timely fashion.
• Identify opportunities and take action to build relationships between one’s area and other areas, teams, departments, or organizations to help achieve business goals
• Understand regulations and communicating proactively regarding regulations
• Comprehend and maintain highly detailed information
• Assess problems and implement solutions
• Accept and carry out responsibility for direction, control, and planning
• Facilitate change: Encourages others to seek opportunities for innovative approaches to more effectively address out-of-network-related problems; facilitates the implementation, communication, and acceptance of productive change within the workplace
  Ensure the patient perspective is a driving force behind actions and business decisions; crafts and implements service strategies that meet patients needs and CSH’s organizational goals from both a national and divisional perspective. (Focus also includes internal and external customers)
• Foster, and strengthen CommonSpirit Health’s external and internal relationships within PSR, providers and departments across the enterprise
• Creatively problem solve, and to achieve the operational and financial goals of both PSR and the broader organization
• Knowledge of:
  
  • Commercial health insurance products, market segments and marketplaces; ability to apply this knowledge to meet specific business goals and objectives
    tools and approaches of financial analysis; ability to read, interpret and draw accurate conclusions from financial and numerical material.
    Ability to stay current with, emerging payer trends, new State and Federal regulations related to out-of-network claims, related to the NSA and results of the IDR process across the country, competitor strategies, etc.
  • Successful negotiation concepts and techniques; ability to negotiate successfully across the organization and with external vendors and clients in a constructive and collaborative manner
  • Technical skills, negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies.
    Must be self-motivated, and able to take ownership of assignments and projects
  • Driven to succeed.
    Strong interpersonal, verbal, and writing skills in dealing with payers and team members with highly developed organizational skills.
    Proven success in project management working with highly complex builds