Contract Manager II, Managed Care

Job Description

Job ID: 1182730
Employment Status: Full-Time
Your Career. Made Better.

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

Includes Provider Relations staff who develop and maintain processes for improvement for the communications between the health plans and BJC entities and resolution of issues in a timely manner. Managed Care contracting resolves plan issues through contract language, and conducts an on-going process for monitoring BJC entity communications regarding managed care contracts and the impact on BJC entities. Represents BJC hospitals to managed care companies for contracting and provider relations. Works with Managed Care Finance to evaluate the financial impact of rate proposals, assuring the financial advantage of each contract. Provides plan administration for second level appeals and serve as the primary technical liaison with the TPA that administers BJC's self-insured health plan.


Join Us!


Role Purpose

Responsible for the negotiation, implementation and ongoing evaluation of designated managed care arrangements. Make recommendations and take action to ensure and enhance the success of hospital and physician managed care participation.


Responsibilities

  • Provides analysis of financial data, including clinical service line reporting, trend analysis, proformas, and forecasts, and the monitoring of key financial metrics.
  • Coordinates communication and implementation of contract provisions.
  • Negotiates contracts on behalf of BJC hospitals and non-physician providers.
  • Coordinates development of rate proposals and reviews rate analysis.
  • Evaluates contracts and leads negotiations as assigned.

  • Minimum Requirements

     

    Degree

  • Bachelor's Degree
  • - Business/HC Admin/related

     

    Experience

  • 5-10 years
  •  

    Supervisor Experience

  • No Experience

  •  

    Preferred Requirements and Additional Job Information

     

    Experience

  • 10+ years

  • Benefits Statement

    Note: not all benefits apply to all openings

    -  Comprehensive medical, dental, life insurance, and disability plan options
    -  Pension Plan*/403(b) Plan
    -  401(k) plan
    -  Tuition Assistance
    -  Health Care and Dependent Care Reimbursement Accounts
    -  On-Site Fitness Center (depending on location)
    -  Paid Time Off Program for vacation, holiday and sick time

    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center


    Legal Statement

    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

     

    Equal Opportunity Employer