Managed Care Contracting

Director, Managed Care Contracts, Phoenix Children’s Hospital, Phoenix, Arizona

Submitted by Roger Evans on Thu, 01/06/2011 - 23:04.
Director, Managed Care Contracts, Phoenix Children’s Hospital, Phoenix, Arizona
 
Description:
 
·       Effectively directs daily operations and activities of the Managed Care Contract Services staff to ensure that all third party payer contracts are negotiated, implemented and managed in accordance with Phoenix Children’s Hospital requirements, established contract parameters and strategic initiatives.
·       Responsible for managing payer contractual relationships and monitoring performance of all managed care contracts for Phoenix Children’s Hospital and Phoenix Children’s Medical Group services, including, but not limited to, acute, behavioral health, transplant and other services.
 
Requirements:
 
·       5 years prior supervisory experience in a managed care environment within a health insurance carrier, hospital or medical group setting.
·       8 years extensive experience in negotiating Managed Care contracts for all provider types: hospital, medical group/IPA, physician, and ancillary providers.
·       Bachelor’s degree in Business, Finance, Health Care Administration, or closely related field.
·       Extensive experience with optimizing contract language and terms.
·       In-depth knowledge of reimbursement methodologies under the Arizona Health Care Cost Containment System (AHCCCS).
·       Knowledge of managed care principles, business models, preferred contract terms, hospital and physician billing, claims payment methodologies, and system requirements
 
EOE/AA Employer M/F/D/V
 
Hospital Description:
 
·       You'll love the work environment we provide. You'll also love the 300+ days of sun every year.
"Make a difference in a child's life" is the invitation-and challenge-offered to the healthcare community by Phoenix Children's Hospital, Arizona's only acute care hospital dedicated exclusively to children.
·       With a 20-year history of providing hope and healing for Arizona families, Phoenix Children's Hospital opened its award-winning new facility in May of 2002. With 290 beds, we are now one of America's ten largest children's hospitals as well as the place to work in Arizona for people with a passion for pediatric healthcare.
 
Our new facility includes:
 
·       149 general pediatric beds, including a 29 bed Hematology/Oncology unit, 30-bed Cardiac/GI unit, 30 bed Pulmonary Respiratory unit, and a 46-bed medical/surgical unit.
·       An 11-bed Biobehavioral unit.
·       A 40-bed Pediatric Intensive Care unit.
·       A Pediatric Emergency Department with 30 rooms: two resuscitation rooms, 14 acute treatment rooms, eight observation rooms and six fast-track rooms.
·       An expanded NICU, including 20 new Level III beds for a total of 100 beds.
·       Five specially equipped operating rooms with the capacity to expand to eight.
·       A pre-procedural area to provide a calming environment where patients and their families can wait for surgeries or procedures.
·       State-of-the-art technology throughout the hospital and outpatient centers.
 
Everyone who works at Phoenix Children's Hospital is devoted to one vital mission: providing hope, healing and the very best care possible to children and their families. Our family-centered care philosophy encourages parents to be part of the healthcare team. We know it's important for parents to be involved in making decisions about their child's care. Our nationally acclaimed Child Life program uses specialists as part of our patient care team to ease children's fears.

Professional Climate:
 
Phoenix Children's Hospital is home to a diversity of challenging, enriching career choices. Our education and professional development programs include comprehensive orientation programs tailored to meet the needs of the individual. The pursuit of advanced degrees is encouraged through our generous tuition reimbursement program.

Benefits:
 
We provide competitive compensation and a benefits package that includes: Medical/Dental/Life/Vision Insurance, Short- and Long-Term Disability, Healthcare and Dependent Care Spending Accounts, 401(k) Plan, Up to $5,000 Annually for Tuition Reimbursement, Paid Time Off, up to $5,000 of Relocation Assistance, Employee Assistance Plan, Child Care Center/Fitness/Computer Discounts, Tax Sheltered Annuities, Employee Referral Program where you can earn up to $2,500, and much more.

Special Features:
 
Away from work, you'll discover how Arizona's rich cultural heritage, 300+ days of sunshine every year, limitless recreational activities and reasonable cost of living combine to create a place where your lifestyle will thrive, too. Sports have become an exciting part of the Valley of the Sun. Whether you enjoy professional baseball, basketball, football or hockey, we've got it all!

Contact:
 
This is a courtesy position posting. Please contact Dr. Evans by e-mail or telephone 507-206-3700 for additional information as to whom you should contact to apply. All inquiries are strictly confidential.
 
Identifiers:
 
Main Category: Other Transplant Related
Subcategory: Managed Care Contracting
TPDC Position ID: AZCH-2011-0001
Position ID or Job Requisition No:
UNOS ID or Other ID: AZCH
City: Phoenix
State/Province: Arizona
Country: USA
Date Posted: 01-06-11

Manager, Payor Contract Services (1050106), University of Pittsburgh Medical Center Corporate Services, Pittsburgh, Pennsylvania

Submitted by Roger Evans on Fri, 09/04/2009 - 11:45.

Manager, Payor Contract Services (1050106), University of Pittsburgh Medical Center Corporate Services, Pittsburgh, Pennsylvania

 

Job Summary:

 

UPMC Corporate Services is currently hiring a full-time manager, payor contract services to assist with the day-to-day operations of the Payor Contract Services Department for its South Side location. This position will work regular business hours Monday - Friday. The manager, payor contract services will be responsible for the planning, review, negotiation, and management of all commercial payor agreements related to UPMC employed physician entities, all hospital and physician transplant agreements and all hospital and physician single case agreements.

 

Responsibilities:

 

·    review and evaluation of all commercial contract opportunities, including both language and reimbursement terms and offer recommendations to the director and others within UPMC as appropriate

·    act as UPMC's primary representative with commercial payors and with UPMC entities regarding commercial payors

·    assist the director of payor contract services in the development of the UPMC payor contract plan and strategies for individual payers and overall, for UPMC

·    seek new opportunities for enhancing UPMC market share or reimbursement through payor agreements or relationship

 

Basic Qualifications:

 

·    bachelor's degree in business administration, accounting, health care management, information systems, or a quantitative field of study (i.e, mathematics, economics, sciences, finance, etc.)

·    a minimum of ten years of relevant experience

·    master's degree in business administration, accounting, health care management, information systems, or a quantitative field of study (i.e, mathematics, economics, sciences, finance, etc.) with seven years of experience will be considered

·    strong written and oral communication and negotiating skills are required

·    a thorough understanding of healthcare contracting and provide/payer relations (hospital or physician)

·    an understanding of basic nomenclature (DRG, ICD9, CPT)

·    understanding of the national and local healthcare market

·    basic understanding of healthcare revenue cycles, both physician/facility and how the interrelate is preferred

·    the ability to work well with a wide variety of customers in a teamwork setting, including internal departmental staff, other UPMC departments, and levels of management, physicians, payers, and third parties

·    healthcare provide experience with a physician concentration background is strongly preferred

 

Salary Range:        33.14  44.69  56.24

 

Contact:

 

Job ID: 1050106

 

Web Link:

 

http://www.upmc.com/careersatUPMC/Pages/default.aspx  

 

UPMC is an equal opportunity employer

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