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Sr. Manager, Contracts Managed Care

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Location: Fountain Valley, California

Schedule: Full-time

Shift: Full-time

Job Listing: MEM005313

Position Summary: The Sr. Manager, Contracts Managed Care is responsible for negotiating moderate to complex payer contracts on behalf of the Foundation.  This includes capitation, FFS and other reimbursement methodologies.  Perform and/or arrange for legal language review on all contracts prior to execution. Oversee the implementation of new contracts with appropriate internal departments, including but not limited to:  UM, IT, QM, Billing, Operations and ACO. Works with Billing and other internal departments to resolve moderate to complex payment and utilization issues.  Support and educate other department staff regarding the interpretation and enforcement of the contractual provisions.

Principal Duties and Responsibilities:

  • Negotiate moderate to complex payor contracts for MCMG, GNP and EMG  including HMO, ACO and FFS contracts.    
  • Analyze impact of contract proposals, including changes to DOFR, anticipate utilization trends, etc.
  • Participate in interdepartmental teams requiring Managed Care expertise
  • Resolve moderate to complex billing issues
  • Assist UM with any authorization issues

Qualifications:

  • Minimum of 5 years’ experience negotiating provider contracts in managed care environment in an IPA, Medical Group, Hospital or Health Plan.
  • Minimum BA, Masters Degree preferred
  • Working knowledge of Microsoft software – Excel, Word, Powerpoint. 
  • Experience working with providers, health plans, members and vendors.
  • Must be able to handle a high volume work load and effectively prioritize work to meet changing deadlines.
  • Must have Excellent communication skills, problem solving and analytical skills; ability to interact effectively with providers and with at all levels within the organization

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Photo of Brindilyn Berger
"I love working at Miller Children's & Women's Hospital Long Beach because I value working for a company that invests in its employees and the community we serve. From the support and guidance I receive from managers who value my professional and personal growth; to being able to work alongside colleagues who are dedicated to help their patients and families. I feel inspired every day to do the work that I love alongside people who share a similar vision."
- Brindilyn Berger, Child Life Specialist

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