Managed Care Senior Manager - FT - Days - MHS

CO010 Memorial Healthcare System; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

Memorial Healthcare System is seeking a corporate level manager to deploy strategic and tactical initiatives for national and regional payor negotiations. The role directs contracting initiatives to secure market-competitive prices for the health system's acute care, ancillary and professional services.

The position emphasizes financial analysis, forecasting, and collaboration with clinical and operational teams to preserve revenue and address payer challenges.

Qualifications

• Bachelor's degree required.
• Five years minimum contracting experience.
• Experience negotiating hospital, professional and ancillary contracts preferred.
• Ability to analyze financial performance and forecast results.

Responsibilities

• Execute complex legal, financial and operational contract negotiations with guidance from senior leadership.
• Lead contracting strategies for all service lines within the health system's integrated delivery network.
• Analyze financial performance, reports and models to support payer negotiations and revenue preservation.
• Plan, hire and develop staff to meet contracting goals and maintain high performance.
• Ensure contracts reflect appropriate reimbursement models and drive market competitiveness.
• Collaborate with clinical and operational leaders to address payer policies, denials and contract issues.

Skills

Negotiations

Financial analysis

Team leadership

Strategic planning

Education

Bachelor's degree

Job description

Location: Fort Lauderdale, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

Corporate level manager responsible for deploying and contributing to strategic and tactical initiatives for negotiations with national and regional payors. Manages execution of contracting initiatives for integrated delivery system to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers. Responsible for securing negotiations of all contractual provisions, implementing appropriate financial reimbursement models, and supporting operations by collaborating with clinical and operational staff to preserve revenue and address payer imposed challenges. Implement strategic and tactical initiatives to achieve organization and department goals.

Responsibilities

• Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation.
• Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services (ambulatory surgical services, skilled nursing facility, rehabilitation facility, home health, home infusion, urgent care centers, sleep lab and other components) of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements).
• Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors.
• Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions, as applicable.
• Enhance, estimate and preserve net revenues.
• Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution.
• Execute strategies and guides operations to protect and build market share.
• Interface with managed care plans on claim reconciliations, trended issues and operational projects.
• Determine root cause and seek resolution.
• Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement.
• Escalate, monitor and manage operational issues from Managed Care Revenue Optimization, Accounts Receivable Management or Joint Operations for solution or potential dispute resolution.
• Advise and support optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs, etc.
• Communicate, coordinate and research to collect information to resolve issues.
• Research new business opportunities (relationships, pricing, services, structures, operations, quality).
• Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands and legislative considerations and changes to the managed care industry to maintain and competitive position.
• Monitor department operations, activities, resources to meet budget and goals.

Competencies

• ACCOUNTABILITY
• BUILDING A BUSINESS CASE
• CONTRACTING - MANAGED CARE PAYORS
• CUSTOMER SERVICE
• FINANCIAL COUNSELING - PATIENT SERVICES
• HEALTHCARE REGULATORY ENVIRONMENT
• LEADING CHANGE INITIATIVES
• MANAGED CARE PAYOR MANAGEMENT
• MANAGING BUSINESS PRIORITIES
• MANAGING INFORMATION
• PEOPLE MANAGMENT
• RESPONDING TO CHANGE
• STANDARDS OF BEHAVIOR

Education and Certification Requirements

Bachelors (Required)

Required Work Experience

Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks.

Working Conditions and Physical Requirements

• Bending and Stooping = 40% Climbing = 20% Keyboard Entry = 60% Kneeling = 20% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 20% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 20% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 0% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Running = 0% Sitting = 60% Squatting = 20% Standing = 60% Walking = 40% Audible Speech = 60% Hearing Acuity = 60% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Bio hazardous Waste = 0% Biological Hazards - Respiratory = 0% Biological Hazards - Skin or Ingestion = 0% Blood and/or Bodily Fluids = 0% Communicable Diseases and/or Pathogens = 0% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 20% Gas/Vapors/Fumes = 0% Hazardous Chemicals = 0% Hazardous Medication = 0% Latex = 0% Computer Monitor = 60% Domestic Animals = 0% Extreme Heat/Cold = 0% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 0% Potential Electric Shock = 0% Potential for Physical Assault = 0% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 20% Shift: Primarily for office workers - not eligible for shift differential

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Equal Opportunity Statement

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing.

Veteran’s Preference

Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power.

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Additional Information

Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well‑being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience. Deeper Caring. Smarter Healthcare. Talk to our patients and their families about "Deeper Caring," and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. About people who advocated for the family’s best interests and cared for them in body, mind, and spirit. For our employees, "Smarter Healthcare" means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting‑edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow. We invite you to share in the Memorial Experience – where touching lives, lifting spirits, and healing the human body is our profession’s greatest privilege and reward. Be where you are valued. Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard.