Corporate Manager, Payer Relations

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

 

Summary:

Responsible for overall day-to-day operational efficiency and financial success of Centralized UR. Reports to Senior Director/Director of Utilization Review to stay connected with corporate functions and meets with Regional Care Management Directors to communicate key trends, process changes, and escalate and address major UR and Payer issues. Key collaborator for UR coordinators and payer portals. Supports training needs as identified for UR Clinical Specialists or UR Coordinators, responsible for collaboration with Training and Education Specialist(s) regarding payer specific information.

 

Essential Duties and Responsibilities:

• Provides oversight for the strategic direction regarding payer relations and collaboration with Contracting.
• Works in close collaboration with Physician Advisors, Revenue Cycle Leaders, SSC Leadership, and Facility Care Management leadership to design and implement payer strategies.
• Provides feedback and support to individual facilities to ensure compliance and optimize outcomes across CHS Enterprise wide.
• Provides direction and education regarding day to day workflow for Notice of Admission verification and payer contacts.
• Maintains working knowledge of payer standards for utilization review. Ensures compliance in both governmental and contractual guidelines.
• Acts as a liaison to provider relations issues related to utilization management concerns.
• Develops relationships with physician advisors and works collaboratively to address status changes, peer-to-peer, and concurrent denial opportunities.
• Remains current on denial trends and performs root cause analyses to address performance.
• Collaborates with the SSC Leadership and Contract Support to update dashboard/reporting, solutions, and training needs based on trends and common issues.
• Collaborates with Training & Education Specialist(s) to address educational needs for Centralized UR staff.
• Reviews all financial reports available, communicates outcomes to team and CM/UR leadership timely and manages utilization review budget.
• Performs other duties as assigned.

 

Qualifications:

• Required Education: High School Diploma.
• Preferred Education: Bachelors in Business or Healthcare related field within 5 years of hire.
• Required Experience: Minimum of 5 years in healthcare related field with 1 year of leadership experience.
• Preferred Experience: Management level Utilization Review support or Patient Access Units
• Computer Skills: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.

 

Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

• The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
• The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
• The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.