Managed Care Contracts Manager - Remote

Option Care; Austin (TX); Remote; USD 83,000 - 139,000; Full time

Job summary

Option Care Health is seeking a Managed Care Contracts Manager to negotiate and implement contracts for home infusion services. This role requires extensive experience in managed care account management, contract analysis, and strong relationship management skills. As a critical member of the team, you will ensure successful contract implementation and address reimbursement issues to optimize efficiency.

Benefits

401k

Dental Insurance

Disability Insurance

Health Insurance

Life Insurance

Paid Time off

Vision Insurance

Qualifications

• 10 years of experience in managed care account management or contract analysis.
• Familiarity with managed care clients and contract terms.
• Experience in home infusion or specialty pharmacy is preferred.

Responsibilities

• Manage negotiation of managed care contracts for home infusion services.
• Oversee the implementation of assigned agreements.
• Resolve reimbursement issues related to contract compliance.

Skills

Contract Negotiation

Financial Analysis

Customer Service

Data Analysis

Communication

Education

High School Diploma

Bachelor's Degree (preferred)

Tools

Microsoft Excel

Microsoft PowerPoint

Microsoft Word

CPR+

Job description

Managed Care Contracts Manager - Remote page is loaded

Managed Care Contracts Manager - Remote

Apply locations Austin, TX time type Full time posted on Posted 2 Days Ago job requisition id R30140

Extraordinary Careers. Endless Possibilities.

With the nation’s largest home infusion provider, there is no limit to the growth of your career.

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees.

As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a thriving workforce that is as unique as the patients and communities we serve. Join a company that is taking action to develop a culture that is inclusive, respectful, engaging and rewarding for all team members. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare.

Job Description Summary:

This role is responsible for the more complex and large account negotiations, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, 340B, and Health System Partnership agreements for home and alternate site infusion services provided by Option Care. Responsible for managed care plans with greater than 250K lives that require more complex negotiation and relationship management. Resolve reimbursement issues arising from contract compliance issues for assigned regions when escalated by Revenue Cycle Management team.

Job Description:

Job Responsibilities (listed in order of importance and/or time spent)

Manage the negotiation of managed care and health system contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care

Oversee internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment.

Manage external implementations and foster ongoing relationships with assigned accounts

Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing.

Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards. Informs contracting leadership of contract risks for assigned third party contracts. Recommends course of action to reduce/minimize risk to the organization. Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation.

Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance.

Strategize with AVP MMS on plans to update and grow a sales representative’s understanding of the scope and intent of assigned managed care or facility contracts. Attends client meetings where appropriate and in collaboration with assigned managed markets representative.

Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts.

Complete credentialing applications when necessary for new contract access as back up to contract coordinator.

Participate in regional meetings as directed by VP, Contracting

Supervisory Responsibilities

Does this position have supervisory responsibilities?

(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

No X

Yes

Basic Education and Experience Requirements

High school diploma and 10yrs of experience in managed care account management or contract analysis and negotiation within the health care industry.

Basic Qualifications & Interests (BQIs)

Experience with contract negotiations involving financial terms for health care services.

Experience in working with managed care clients and familiarity with contract terms and conditions in the ancillary arena.

Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.

Experience providing customer service to internal and external customers, including meeting quality standards for services.

Experience with Home Infusion or Specialty pharmacy

Experience with CPR+ preferred

Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.

Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).

Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).

Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).

Travel Requirements: (if required)

Willing to travel up to 25% of the time for business purposes (within state and out of state).

Preferred Qualifications & Interests (PQIs)

Bachelor's degree and 5-8yrs of experience in contract management and negotiation within the health care industry. (Preferably home infusion or specialty pharmacy space).

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Due to state pay transparency laws, the full range for the position is below:

Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

Pay Range is $83,161.63-$138,610.06

Benefits:

-401k

-Dental Insurance

-Disability Insurance

-Health Insurance

-Life Insurance

-Paid Time off

-Vision Insurance

Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.