Strategic Managed Care Operations Leader

Silver Cross; New Lenox (IL); On-site; USD 138,743,606 - 173,415,043; Full time

Benefits offered by this job

Medical, Dental and Vision plans

Life Insurance

401(k) plan with match

Wellness program

Tuition Reimbursement

Job summary

Silver Cross Hospital in New Lenox, IL seeks an Operations Manager, Managed Care to oversee the PHO and hospital contracts, aligning pricing, program development and physician relations. You will drive government and commercial payor initiatives while expanding revenues and ensuring regulatory compliance.

Key responsibilities include implementing utilization management, partnering with EHP, and guiding vendor relationships within the PHO ecosystem.

Qualifications

• 10 years of experience in healthcare with payors, hospitals or consulting firms.
• Experience with Medicare Advantage and government programs.
• Direct Contracting with large employers.
• Experience partnering with physician organizations.

Responsibilities

• Run day-to-day operations for governmental and managed care contracts to strengthen network physicians.
• Implement utilization management, quality and risk coding programs.
• Develop and maintain strategies for network development with PHO and EHP.
• Review contracts annually and negotiate pricing to maximize profitability.
• Coordinate pricing, contracting and program development across the PHO and hospital.

Skills

Payor contracting experience

Population health programs

Medicare Advantage knowledge

Physician organization collaboration

Education

Bachelor's degree in Business Administration or related field

Job description

Silver Cross Hospital in New Lenox, IL seeks an Operations Manager, Managed Care to oversee the PHO and hospital contracts, aligning pricing, program development and physician relations. You will drive government and commercial payor initiatives while expanding revenues and ensuring regulatory compliance.

Key responsibilities include implementing utilization management, partnering with EHP, and guiding vendor relationships within the PHO ecosystem.