Managed Care Contracts Manager

We are an equal opportunity employer. All qualified applicants will receive consideration for employment. We do not discriminate for any reason. We welcome talented individuals who believe in our mission, drive the organization forward, and recognize the positive impact they can bring to our communities.

Who We Are

If you want to work for a mission-driven organization that’s impacting community health care both on a local and national level, then Access Community Health Network (ACCESS) may be the perfect place for you. As a nationally recognized leader in community health, we continue to innovate and improve our integrated care model to address the total health and wellness of our patients. Our dedicated staff are committed to advancing health equity and making a long-term impact on the health outcomes of the more than 150,000 patients that count on ACCESS as their medical home each year.

Position Summary

The Managed Care Contracts Manager manages the daily operations of the Managed Care Department, including a team and processes to design, analyze, negotiate, implement, and monitor managed care contracts.

Core Job Responsibilities

• Manage day to day interactions with health plans. Collaborate with other departments to understand and communicate issues to health plans
• Responsible for the review and monitoring of managed care contracts including compliance to contract terms, requirements from provider manuals and any other related contractual documents; performs audits based on contractual agreement and establishes corrective action plans as necessary.
• Ensures managed care contracts are in support of ACCESS care model and associated standard access to care, care coordination, case management, quality metrics
• Responsible for reviewing managed care contract information and creating materials to help disseminate new and/or updated information to a variety of ACCESS audiences.
• Provide data analysis and performance reporting in support of managed care contracts and program efforts, including financial modeling
• Manages day to day claims processing operations
• Manage direct reports, communicating expectations, providing coaching and feedback, monitoring and managing performance and providing development opportunities
  
  

Requirements

• Bachelor’s degree
• Minimum of 3 years’ experience in a healthcare provider or managed care operations
• Minimum 2 years’ experience managing staff
• Intermediate proficiency in Microsoft Office (especially in Word, Excel, and PowerPoint)
  
  

Preferred Qualifications

• Degree in health or business field
• Experience negotiating contracts and terms
• Experience in financial modeling
  
  

Benefits

• Tuition reimbursement and student loan forgiveness programs for qualifying individuals
• Comprehensive healthcare coverage including Medical, Dental, and Vision
• Generous PTO after introduction period
• 403(B) retirement plan and financial resources to help you save and plan for your retirement
• Life Insurance
• Opportunity to participate in cross-departmental committees to innovate and transform our care delivery model and our workplace
  
  

ACCESS is a Network of Federally Qualified Health Centers treating patients on the frontlines of community-based health care. Depending on position applied/being recruited for, candidates may be required to be vaccinated against communicable diseases and provide supporting documentation proving that they are properly vaccinated, or apply for religious and/or medical vaccination exemption as a part of the application process.

The pay ranges provided represent the minimum to mid-range for positions. Actual compensation will be determined based on a combination of factors including years of experience, educational background, market conditions, and available grant funding.