Associate Director Managed Care Contracting

Department:

13212 Enterprise Corporate - Managed Health Clinical insights & Operations: Contract Management

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

8am-5pm, M-F, Remote

Variability in hours based on various project requirements

Pay Range

$51.05 - $76.60

Responsible for managed care portfolio performance for assigned payors. Implementation of contracting strategy for the System. Monitor contract performance versus expected, and recommend any action needed. Completes multi-level analysis of contract language understanding current implications to the Total Enterprise. Able to review complete existing and proposed contract language and identify current risk and impact to the Total Enterprise.

Essential Functions

• Assists in the development and implementation of the System's strategies and objectives related to managed care contracting for assigned Managed Care Organizations.
• Responsible for rate and language negotiation of assigned payor agreements. Negotiates rate and language of major payor agreements with AVP support. Assists with the development of negotiation strategy for major payors. Negotiates rate and language of major payor agreements independently when the scope of the negotiation is limited.
• Assists in negotiations and maintenance of collaborative/value based managed care agreements including but not limited to provider tiering and performance reporting.
• Monitors, regularly reviews and report financial and operational performance of assigned payor contracts versus expectations. Recommend any action needed as a result of contract performance.
• Gathers and analyzes data and apply methodologies. Draw preliminary conclusions and project application(s). Identify cross-application of data or analysis, directing efforts of other associates, as needed.
• Creates and implements, based on Management feedback and information supplied by other System entities, managed care contracting policies and procedures to maximize System performance in managed care relationships.
• Provides System with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives. Draw conclusions and recommend any action needed based on analysis of industry trends.

Physical Requirements
Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.

Education, Experience and Certifications.
Bachelor's degree required, Master's degree preferred (MBA or MHA preferred). Minimum of 5 years experience as a contract negotiator with a large provider or 7 years small provider or payor experience as a contract negotiator with a Bachelor's degree. -OR- Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Master's degree.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program