Regional Manager - Managed Care

Overview

At Saint Clare's Health, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, Saint Clare's Health is actively seeking new members to join its award-winning team!

 

Saint Clare's Health includes CMS 5-Star Rated hospitals and is an award-winning provider of safe, high quality, compassionate care, serving the communities of Morris, Warren and Sussex counties. Its network of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging Center in Parsippany, among other satellite locations. The hospitals have received multiple quality awards including Leapfrog “A” ratings for patient safety; Healthgrades recognition for orthopedic surgery, treatment of stroke, heart care, various surgical procedures, and more. For information, visit www.saintclares.com.

 

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

Regional Manager, Managed Care is responsible for managed care contract management and payer relations. The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; maintain managed care infrastructure; assist in the measurement of payer compliance with contract terms; JOC management; and assist hospital, business office and physician group management in resolution of issues related to managed care agreements.

Qualifications

EDUCATION, EXPERIENCE, TRAINING 1. Bachelor of Business/health/management field or relevant bachelor’s degree2. Minimum of 3 years of contract negotiation/managed care experience at a healthcare provider or managed care company preferred.3. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management.4. Excellent verbal and written communication skills