Job Information
Prime Healthcare Regional Manager - Managed Care - PMC Admin-Corporate in Kansas City, Kansas
Overview
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Providence Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Providence Medical Center, located near I-435 and Parallel Pkwy in Kansas City, Kansas, offers an extensive array of diagnostic and medical care. Key services include nationally recognized cardiovascular care, critical care, surgery, neurosurgery, orthopedics, pulmonary services, 24/7 emergency services and wound care center. The hospital is accredited by The Joint Commission and is a member of Prime Healthcare. For more information visitwww.providencekc.comor call 913-596-4000.
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
* This position can sit in any Prime Healthcare Hospital *
Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed care agreements in place at all hospital facilities and employed physicians. The Regional Manager effectively interacts with Corporate Executive Management, Hospitals, and Business Office Management and Medicare, Medicaid, exchange and commercial insurance payers. The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; assist in the measurement of payer compliance with contract terms; participate in JOCs; and assist hospital and business office management in resolution of issues related to managed care agreements. This position o ffers a competitive compensation and great benefits.
In this role you will be responsible for Negotiation, Contract Managment, Healthcare Agreements, Payer Contracts, Reimbursement Rates and Health Insurance. Involving Medicare/Medicaid, Value-Based Care, Healthcare Laws and Fee Schedules.
Qualifications
EDUCATION, EXPERIENCE, TRAINING 1. Bachelor of Business/ Health/ Management field or relevant bachelor’s degree 2. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management 3. 5 years of contract negotiation/managed care experience in a hospital or hospital system setting, required 4. Previous behavior health contracting, joint operating committee and C-suite collaboration experience is a plus 5. Business office and claims knowledge and/or experience, preferred 6. Must obtain Sexual Harassment Certification within 6 months, and then maintain biennially.
We are looking for someone who has #contractnegotiations in a #managedcare environment. Experience working in #healthcare working with #healthinsurance companies is a must.
Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175258/regional-manager---managed-care---pmc-admin-corporate/job?mode=apply&apply=yes&in_iframe=1&hashed=-336024306)
FacilityProvidence Medical Center
LocationUS-KS-Kansas City
ID2024-175258
CategoryManager
Position TypeFull Time
ShiftDays
Job TypeExempt