Sr. Contract Manager Transplant

Company Description

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

Job Description

General Summary

Under the supervision of the Director of Payer Relations & Contracting, serves as key liaison to UMMC and FPI leadership as well as physician, clinical and administrative staff for physician and hospital specialized, high-cost service contracting.  Acting as the primary contact with payor organizations and national Center of Excellence networks, utilizes revenue protection strategies to assess contracting opportunities, conducts contract negotiations/re-negotiations, and manages contract/payor relationships to improve actual/expected revenues and maximize volume.  In addition, this position may work with a service line product management to discuss challenges with transplant programs so that comprehensive marketing programs may be developed to assist with increasing volume for selected specialized programs.  Conducts market research as necessary, and engages and secures buy-in of UMMC, FPI and physician leadership, clinical and administrative staff for awareness and compliance with appropriate market quality and patient safety initiatives.  Utilizes appropriate marketing, sales and outreach tools to raise awareness, emphasize the strengths and competencies, and encourage consumers, physicians and insurers to use specialized tertiary services at UMMC.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Establish and maintain relationships with managed care referral sources, including local, regional and national payors, re-insurers, and national Center of Excellence (COE) networks. Serve as main resource regarding Managed Care market trends.

   • Maintain payor/national COE network profile information.

   • Collaborate with Strategy & Business Development and Marketing Departments to assess payor market share and project potential volume from COE networks.

   • Facilitate submission of national COE quality surveys -which support UMMC Strategy & Business Development and Marketing initiatives.

   • Maintain Payer Relations and acts as System resource for COE contracting.

   2. Market program, services and key physicians directly to payors/national COE networks.

   • Introduce key faculty/programs and physician/hospital leadership to payor/national COE Medical Directors and payer staff.

   • Promote University of Maryland Faculty Physicians (FPI) and UMMC programs to payers and national Center of Excellence networks.

   • Facilitates & hosts site visits by national COE network leaders.  

   3. Negotiate/re-negotiate specialized contracts, including professional and facility services, to achieve optimum reimbursement and risk protection under fixed rate agreements. Primary contracting focus for both risk and/or non-risk, non-traditional contracts for Bariatric, Cardiac, - Transplant, Cancer Care, Neurocare, Orthopedics and other service lines that national COE networks require non-traditional contracting for inclusion in their programs.

   • Develop and negotiate scopes of service to limit financial risk and to facilitate contract operational performance.

   • Identify and negotiate risk corridors, exclusions, bill aboves, and other contracting strategies to minimize financial risk; will require significant interaction with clinical faculty and staff associated with clinical services.

   • Conducts pricing and ongoing analysis of financial reimbursement performance of assigned service line agreements.

   • Negotiate optimal reimbursement for Physician practices and UMMC.

   • Collaborate with Director of - Payer Relations & Contracting, - FPI, and Physician/Hospital leadership to finalize contract language and payment rat