Managed Care Manager

Regular Full-Time 225 Willow Brook Road, Freehold, NJ CentraState Healthcare System
[ Overview ]

CentraState Healthcare System is seeking a highly motivated, team player to join our organization as Manager of Managed Care. Under the supervision of the Corporate Director, the Manager of Manager Care is responsible for implementing CentraState’s managed care and value-based care contracting strategy. This position is responsible for managing payer relationships, supporting contract and risk arrangement negotiations including financial impact analysis of reimbursement and contract language for facility and ancillary agreements. This position will serve as a critical resource in supporting, managing and driving strategic projects; and the development and execution of key business strategies for CentraState’s managed and value-based care portfolio. 

[ Responsibilities ]
  • Develop and evaluate payment rates and strategies for managed care contracting
  • Manage contracts to ensure compliance and provide direct support renewing and renegotiating contract terms.
  • Oversee the production of financial analysis and projections for the negotiation of contracts.
  • Analyze the managed care environment; monitor and communicate trends in national, regional, and local markets.
  • Conduct managed care contract language reviews, in conjunction with Director and Legal, for existing and new contracts.
  • Work closely with patient financial services in the audit of payments to ensure payor compliance with contract terms and payment methodologies
  • Perform payor-specific reporting and analysis of healthcare industry trends including the impact of new payor policies and government regulations.
  • Act as primary liaison with managed care plans in addressing operational issues arising under the managed care contracts.
  • Interpret contract language and ensures that the terms of contracts are communicated and implemented accurately within the system. Resolves issues relating to health plan credentialing, claims payment, utilization management, and various administrative issues.
  • Collaborate with the Revenue Cycle Team to manage denials as engage in denial avoidance strategies.
  • Support in the negotiation and execution of value-based payment programs with Managed Care Companies, such as pay for performance, episodes of care and bundled payments
  • Responsible for closely managing CentraState’s performance on its risk-based contracts, involving key staff and physicians as necessary. 
  • Manage staff and provide direction to ensure proper prioritization of time, strategic planning, and team work. Responsible for coaching, skill development, performance appraisal and motivation of staff.
[ Qualifications ]
  • Bachelor’s Degree in healthcare, finance, or related field, Masters preferred.
  • A minimum of 5 years of experience in Hospital-based managed care and value-based payments, or closely related area, hospital billing and/or denial management experience, a plus.
  • Demonstrated knowledge of Federal and State Regulations, including Medicare and Medicaid, ERISA, and DOBI.

Preferred Knowledge, Skills and Abilities:

  • Excellent negotiation, strategic, analytical and financial skills
  • Effective written and verbal communication skills across a variety of audiences, with the ability to influence change; coupled with a direct customer focus
  • Knowledge of both payer and hospital managed care operations
[ Physical Demands ]
[ Commitment to Diversity and Inclusion ]

CentraState Healthcare System prohibits discrimination based on arbitrary consideration of such characteristics such as race, color, religion, national origin, ancestry, gender (including pregnancy), affectual or sexual orientation, gender identity or expression, marital status, age, physical or mental disability or limitation, medical condition, genetic information, or veteran or military status, as well as any other legally protected class of persons and acts, in accordance with applicable State and Federal laws.