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Develops and implements strategic, operational, and tactical business plans to meet customer service requirements and optimize financial performance. Maintains and develops relationships with health plans and medical groups. Develops contracting plans and forecasts. : Directs and performs the negotiation of contracts with managed care payers and group purchasing organizations. Monitors existing contract performance. Conducts financial analyses and considers impact of applicable regulatory requirements. Collaborates with senior management and/or multiple decision-makers to conclude sales. Serves as liaison between customer and company personnel on administrative matters. Develops and assists in implementation of referral strategies. Develops and manages the budget. Controls expenses while meeting operational, financial, and service requirements. Recruits, develops, and motivates staff. May lead team of sales/technical/marketing personnel on larger sales efforts.

Top Managed Care Executive

Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMO's, PPO's, long-term care). Organizes and develops short- and long-term planning programs to ascertain community and organization's requirements. Typically reports to Hospital Administrator and directs subordinate staff.: Administers fiscal operations such as budget planning and establishing rates for alternative delivery services. Directs activities concerned with contracts for alternate delivery systems. Reviews bids for conformity to contract requirements and determines acceptable bids. Negotiates contract with bidder. Requests or approves amendments to or extensions of contracts. Develops policies and procedures for various activities to assure objectives of hospital, managed care, physicians, care givers and patients are met. Ensures compliance of facilities with all regulations. Ensures that all providers and employees meet and maintain requirements and licenses. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures, progress reports, etc., in order to inform management of current status of work activities. Recommends measures to improve methods, performance, and quality of service, and suggests changes in working conditions to increase efficiency. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. Analyzes department budget to identify budget needs and or reductions, and may allocate operating budget's funds. Interprets company policy to employees and enforces safety regulations.

Managed Care Head

Top Provider Network Contracting Executive

Provides executive leadership and coordination over Provider Network Contracting operations to include development and implementation of strategic plans that provide sound provider interaction and contracting.: Responsible for the research, policy development, contract development and expansion of the provider network. Plans, organizes and directs the Provider Network Contracting department. Organizes, controls, and evaluates the implementation of strategic plans that provide strong provider relations and contracting. Formulates and administers departmental policies. Plans, organizes, implements and evaluates outcomes of the department’s strategic plans. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to provider network contracting. Develops new strategies to enhance service and improve overall performance. Develops and maintains administrative and regulatory compliance systems. Reviews budgetary recommendations, and manages and monitors the departmental budget. Hires, develops and motivates a qualified staff. An advanced degree is typically required for this position with seven years of provider relations and contracting experience in managed care.

Managed Care Contracting Manager

Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.: Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. Responsible for the oversight of all contract coordination activities. Represents the organization to the employer community and solicits business. Works with current subscribers to develop additional business opportunities. Coordinates contract negotiation and resolves complex issues. Works closely with physicians in program development and specialist relations. Monitors managed care contract performance and addresses related concerns. Evaluates potential business opportunities and develops innovative approaches that can benefit the organization. Attempts to standardize contracts to ensure effective and efficient implementation. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.

Supervisor Managed Care

Supervises and coordinates the activities of personnel in the managed care department of a healthcare facility to ensure department productivity and quality goals are met. Assists with the analysis of the financial and operational impact of managed care contracts and the maintenance of related databases within the overall structure developed by the Director of Managed Care. Participates in and provides oversight of contract compliance activities and maintains relationships with key health plan contacts. Serves as a liaison to Finance Department regarding managed care related issues.: Hires, schedules, and monitors staff in the Managed Care Department. Ensures employees receive appropriate orientation and training to perform their jobs, including writing and communicating standard operating procedures. Tracks employee time and attendance. Provides financial data to management as well as other reporting concerning daily operations within the department. Tracks, communicates, and compares key terms and conditions and reviews the language of all managed care contracts to ensure terms and conditions meet the standards established by the Managed Care Department. Manages multiple projects within required timelines. Performs data entry, maintenance, and reporting for database of all active contracts as well as other hospital information systems. Supports negotiations by providing reports or other contract comparison tools. Negotiates with health plans on a case by case basis for services not covered under contract.

Head of Medical Contracting

Negotiates to draw up contracts for managed care services related to physician groups. Negotiates, administers, extends, terminates, and renegotiates contracts. Formulates and coordinates proposals. Coordinates activities of workers engaged in formulating bid proposals. May report to Top Managed Care Executive, Chief Executive Officer, or Chief Financial Officer in organization.: Evaluates or monitors health outcome and contract performance to determine necessity for amendments or extensions of contracts, and compliance to contractual obligations. Approves or rejects requests for deviations from contract specifications. Arbitrates claims or complaints occurring in performance of contracts. May serve as liaison officer to ensure fulfillment of obligations by contractors.

Medical Contracting Head

Medical Head of Contracting

Contract Compliance Representative

Determines provider compliance throughout a region and recommends appropriate actions.: This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Conducts ad hoc investigations. This position typically requires a college degree in math, economics or a related field and three years of underwriting experience.

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