Manager Managed Care Contracting

BJC HealthCare; Missouri; On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Comprehensive medical insurance

401(k) with match

Tuition Assistance

Paid Time Off

Adoption assistance

Job summary

BJC HealthCare in Missouri seeks a Manager of Managed Care Contracting to oversee value-based contracting and negotiate with insurance providers. The role involves collaborating with leadership to develop strong relationships with Managed Care Organizations and ensuring compliance with contractual obligations.

The ideal candidate has at least 5 years of experience in managed care contracting and a Bachelor's Degree. Comprehensive medical and retirement benefits are provided.

Qualifications

• 5-10 years of experience in managed care contracting or related field.
• 2-5 years supervisory experience is required.
• Strong understanding of coding and documentation practices.

Responsibilities

• Manage and lead contract negotiations with Managed Care Organizations (MCOs).
• Facilitate problem solving of contractual issues.
• Ensure compliance with payer-specific requirements.

Skills

Negotiation skills

Leadership

Contract analysis

Communication

Healthcare industry knowledge

Education

Bachelor's Degree

Master's Degree

Job description

BJC is seeking a Manager of Managed Care Contracting. This role oversees value‑based contracting across the organization, including negotiating with insurance providers and implementing contract agreements. The ideal candidate will have prior experience with value‑based contracts and a strong understanding of coding and documentation practices.

Must be located in the greater St. Louis area.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long‑term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes–Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value‑based care and payment programs, payor and provider relations, and direct to employer solutions.

Preferred Qualifications

Role Purpose: In collaboration with leadership, the Managed Care Contracting Manager manages and leads the contract negotiations with the Managed Care Organizations (MCOs), including rate and language discussions in accordance with established guidelines and aligned with BJC strategic goals. This position develops and maintains strong relationships with the Managed Care Organizations (MCOs). This position also collaborates with the HSOs in order to identify challenges and opportunities for improvement around contract performance.

Responsibilities

• Manages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
• Negotiates complex managed care contracts on behalf of the BJC HSOs including hospitals, physicians, home care, behavioral health and other ancillary providers; leads contract discussions with managed care organizations, including reviewing and drafting contract language provisions that protect BJC’s revenue and improve administrative functions and negotiating rates within established guidelines.
• Facilitates problem solving of identified contractual and operational issues in collaboration with managed care organizations and internal stakeholders; identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
• Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts; leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
• Coordinates with analytical team to ensure contractual terms, including payer‑specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems.

Minimum Requirements

• Education: Bachelor’s Degree
• Experience: 5‑10 years
• Supervisor Experience: 2‑5 years

Preferred Requirements

• Education: Master’s Degree
• Experience: 10+ years
• Supervisor Experience: 5‑10 years

Benefits

• Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date
• Disability insurance paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

Benefits Summary

Legal Statement

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer.