System Manager Managed Care

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Location

BHG Bronson Healthcare Group

Title

System Manager Managed Care

Job Description

The System Manager for Managed Care is accountable for the development, implementation, and ongoing improvement of all Managed Care-related activities across the system. This includes, but is not limited to, all Managed Care functions listed below. The System Manager is also responsible for providing day-to-day leadership in coordinating departmental activities, personnel matters related to employment, training, mentoring, coaching, and staff development. The System Manager is responsible for the following:

• Development and management of positive relationships with payors and internal customers.

• Assisting the System Director of Managed Care in conducting payor contract review and negotiation activities as needed.

• Designing, monitoring, and enhancing organizational processes to minimize non-value-add work and maximize efficiency, such as underpayment review processes, departmental dashboards to monitor key performance indicators, settlement prospects, opportunities to address payor denials, and payor performance dashboards.

• Collaborating with departmental leaders to gather input on managed care contracting, credentialing, and other activities to improve departmental services.

• Leading payor credentialing and delegated credentialing activities, including identifying areas for improvement in collaboration, process redesign, automation, and revenue generation for administrative services.

• Designing and implementing new processes and procedures for payor underpayment reviews, contract modeling, fee schedule analysis, and other analytical functions to support the department.

• Effectively navigating a challenging environment and utilizing leadership skills to solve problems and escalate decision-making as necessary.

• Establishing a course of action for self and others to accomplish specific goals; ensuring proper assignments and efficient allocation of resources.

• Actively participating in Management Committee meetings.

Employees providing direct patient care must demonstrate competencies specific to the population served.

Additional Job Description

• Bachelor’s degree in Healthcare, Business Management, or a related field, with 3-5 years of relevant experience required.

• Prior management experience in managed care-related disciplines preferred.

• Demonstrated knowledge of Managed Care, contract negotiation, Revenue Cycle, and process improvement functions.

• Ability to coach and mentor staff using tactful and positive feedback to improve performance.

• Strong communication skills when negotiating with payers.

• Ability to problem-solve with peers and internal departments and effectively encourage a broader perspective beyond departmental issues.

• Ability to accept and provide constructive feedback for team development.

• Effective communication with physicians and practice leaders to prioritize and distill payer information that is most relevant.

Physical and Mental Demands

• Work involving high levels of mental and visual fatigue, e.g., repetitive or detailed tasks requiring concentration for extended periods, as well as the operation of a personal computer or CRT for 40 to 70 percent of the time.

• Some physical demands typical of jobs requiring regular walking, standing, stooping, bending, sitting, and lifting light objects.

Key Responsibilities

• Implementation of:

  • Analytics and contract modeling functions and processes within the Managed Care Department.

  • Formal policies and procedures to document standard work.

  • Ensuring staff adherence to standard work.

  • Identifying ways to automate processes and eliminate waste and duplication.

  • Identifying and implementing an automated contract management system.

• Participation in the development and administration of the departmental budget.

• Development and administration of departmental policies and procedures.