Managed Care Contracts Lead: Negotiation & Implementation

Pomona Valley Hospital Medical Center; Pomona, Northern (CA, KY); Hybrid; USD 120,000 - 137,000; Full time

Benefits offered by this job

Competitive weekend rate

Job summary

Pomona Valley Hospital Medical Center is seeking a Managed Care professional to negotiate and implement the hospital’s managed care agreements, coordinating with payers and PVHMC departments to ensure successful adoption and ongoing performance.

You will review trends, model rate proposals, analyze contract performance, research statutes and regulations, and maintain orderly contract documents while supporting efficient department processes.

Qualifications

• Valid California Driver's License and ability to drive to off-site negotiations and meetings.
• High School diploma or equivalent.
• Two years' managed care negotiation experience.

Responsibilities

• Negotiate and implement the hospital’s managed care agreements as assigned by the Director of Managed Care.
• Coordinate managed care activities with payers and PVHMC departments to ensure successful implementation and problem-solving.
• Review and report trends, model rate proposals, and analyze overall contract performance.
• Review, analyze and recommend contract language; research statutes and regulations related to managed care.
• Ensure department processes are efficient, and that contract documents are kept in a controlled and orderly manner.
• May perform other duties as assigned.

Skills

Negotiation

Contract analysis

Regulatory knowledge

Education

High School diploma or equivalent

Bachelor's Degree (preferred)

Job description

Pomona Valley Hospital Medical Center is seeking a Managed Care professional to negotiate and implement the hospital’s managed care agreements, coordinating with payers and PVHMC departments to ensure successful adoption and ongoing performance.

You will review trends, model rate proposals, analyze contract performance, research statutes and regulations, and maintain orderly contract documents while supporting efficient department processes.