Senior ACO – PHO Manager of Managed Care Contract – Remote in MA, FL, TN, NH, NC, Ohio, Texas, Kansas, MI, VT, CT, MO, RI

Req#: R20860
Category(s): Finance, Supply Chain
Full Time / Part Time: Full-Time
Shift: First

This is a remote position for MA, FL, TN, NH, NC, Ohio, Texas, Kansas, MI, VT, CT, MO, RI residents

Baystate Health, western Massachusetts’s premier healthcare provider, and home to Baycare Health Partners a Provider Hospital Organization (PHO) serving the four Baystate hospitals and close to 140 medical practices throughout the Pioneer Valley of Western Massachusetts is seeking a Manager of Managed Care Contract.

Manager of Managed Care Contract – Position Priorities

The Manager of Managed Care Contract position will be responsible for a wide variety of duties related to the development, implementation, and ongoing management of the Baystate Health (BH) & Baycare Health Partners (BHP) managed care contracting function. The BH & BHP contracts contribute to the overall mission, vision and strategy of BH with a focus on the IHI triple aim initiative. Primary responsibilities include contract administration, review and analysis of contract proposals, development of managed care strategies, and a liaison role to both external and internal customers and other special projects.

Assist in the development of an overall strategy for the managed care activities for BH and BHP. Review contract language, rate and fee proposals, complete market analysis comparisons and evaluate proposal and present to BH & BHP senior leadership and membership

Participate, develop, maintain and communicate alternative payment methodologies (risk sharing, shared savings, bundle & global payment arrangements, pay for performance programs, etc.)

Act as a liaison to internal BH & BHP customers, BHP member committees (Board, CAC, CIAC, R&R and PMAG), and external partners (payer contracting and provider relations management)

Disseminate and understand healthcare market and industry changes including impacts due to Affordable Care Act, Massachusetts Health Exchange and regulatory requirements and communicate the impact of these changes to the BH & BHP partners

Provide supervision and mentoring of respective managed care staff (Senior Contract Administrator & Contract Administrator Associate positions)

Follow-up and address with payers global contracting issues encountered by practices/members. Ensure and interpret payer compliance to contract language and provisions and follow-up on any issues as appropriate

Develop, review and communicate operational and clinical requirements. Assist with pay for performance and bonus program settlement and distribution process

Required Work Experience: 

5 years Healthcare, Managed Cared, Payer expertise

Preferred Work Experience: 

PHO, ACO, Provider focus or experience

Skills and Competencies: 

Excellent communication and presentation skills, financial acumen, relationship building, knowledge of antitrust laws and regulations, ability to tactfully navigate healthcare environment with various key parties

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Bachelor of Science (Required), Master of Arts

Certifications:

Equal Employment Opportunity Employer

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