Managed Care, Operations Manager

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Job Summary
The Managed Care Operations Manager is responsible for assisting with all aspects of managed care contracting, network development, and payer relations for the hospital system. This role will develop, implement, and manage strategies to optimize reimbursement, enhance network performance, and ensure compliance with regulatory standards

Reports to:

Job Specific Responsibilities
Daily assignments may include but are not limited to:
• Lead and mentor a team of managed care professionals participating in all staff related responsibilities that include but not limited to: hiring, coaching, training, providing guidance and support, professional development, employee engagement, disciplinary actions, etc..
• Lead negotiations with insurance providers, health plans, and third party payers to secure favorable terms for the hospital system
• Negotiate and review managed care contracts, new commercial payers contracts, Medicaid, Medicare, and other third party payers to ensure alignment with organizational objectives and financial goals
• Collaborate with other hospital departments to strengthen partnerships and network development
• Build and maintain strong relationships with stakeholders and maintain a provider network that maximizes access to high quality care at optimal costs
• Monitor and evaluate the financial performance of managed care contracts, including revenue cycle optimization and reimbursement rates
• Work with financial and operational leaders to set targets, measure results, and adjust strategies to ensure financial sustainability
• Ensure compliance with federal, state, and local healthcare regulations and managed care policies
• Performs other related duties to Managed Care, as required

Education and Experience
• Bachelor’s Degree in Healthcare or Business Administration, or related field of study
• + 5 years of managed care experience, healthcare reimbursement systems, payor contracting, and network management. Some experience with negotiating in local market is helpful
• + 3 years leadership experience, leading people and/or processes, preferably in a healthcare environment

Required Licensures/Certifications/Registrations
• N/A

Skills and Abilities
• Strong relational skills and the ability to influence and hold others accountable
• Effective communicator, both verbally and in writing; Strong negotiation and interpersonal skills
• Strong analytical and quantitative skills; proficient user of data spreadsheets; Ability to analyze complex data and make date- driven decisions
• Demonstrated understanding of healthcare laws, regulations, and compliance requirements

Interaction with Other Departments and Other Relationships
This position will frequently interact with Patient Financial Services (Patient Accounting), and other areas of the hospital system and with Texas Tech Health Sciences Center (TTHSC), various payors, health plans, and providers.

Physical Capabilities
Occasionally exerts up to 25lbs of force and/or frequently exerts a small amount of force to lift, carry, push, pull, and move objects. Work involves sitting most of the time, but may involve walking and/or standing for brief periods of time. This position requires frequent typing/keyboarding and some reaching in all directions. Must be available to work 8:00 am to 5:00 pm Monday through Friday plus after hours as needed. Be available by cell phone as needed.

Environmental/Working Conditions
This position is subject to inside environmental changes that may include constant change in temperatures. Department at times may be noisy due to constant patient interaction and phone usage

Direct Reports
N/A

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

*Request for accommodations in the hire process should be directed to UMC Human Resources.​*