Contract Manager - Managed Care (Finance)

Primary Functions:

Nemours Children's Hospital, Florida is seeking a Contract Manager - Managed Care (Hybrid) (FULL-TIME), to join our team in Jacksonville, FL.

This position is responsible for the coordination of crafting, evaluating, and execution of contractual negotiations, as directed by the director, which includes contract performance overview and analysis, and language review for hospital, specialist, primary care and urgent care agreements. Contractual negotiations include, but not limited to, fee-for-service, capitated, Clinically Integrated Networks, Value-Base Pay for Performance and Risk agreements. This position works directly with Managed Care's leadership during negotiations.

This position also manages the payer contractual relationship and functions as a liaison between the Managed Care Organizations (MCO'S) and The Nemours Foundation and affiliates.

Essential Functions:

• Work with interdepartmental team members to analyze rate proposals from and to MCO's and offer direction and recommendations to management during negotiations.
• Monitor contracts and move forward with close-out, termination, extension or renewal according to strategy.
• Solve or investigate any contract-related problems that may arise with other parties and internally with Nemours.
• Research and provide answers to contractual questions posed by various departments within Nemours.
• Work with internal staff to assemble and analyze audit reports to ensure the accurate development and maintenance of provider networks and reimbursement contracts, and compliance by the MCO's.
• Communicate and present information to stakeholders about all contract-related matters.
• Support the Provider Enrollment management and staff to aid if needed on lowering enrollment timelines.
• Negotiate rates and language on single case agreements and track all via spreadsheet.
• Maintain records for correspondence and documentation in relation to established contract and those in progress.
• Review risk contract models and agreements as needed.
• Responsible for supporting the Provider Enrollment Management Team on negotiating Delegated Agreements.
• Notify MCO's of annual charge master increases and any other material changes within Nemours, and work with the MCO's to implement necessary changes or updates (e.g., payment discounts, etc.).
• Work cohesively with other areas of the Managed Care Department to identify and resolve provider, network, and contractual issues, as they arise. Build and foster positive working relationships with contracted and non-contracted MCO's, as well as various departments within Nemours' own organization.
• Provide regular updates to management of the status of contractual compliance of participating MCO's and keeping management apprised of non-contracted MCO's.
• Maintain managed care files such as but not limited to rate grid, contract calendar, Teamshare files, updates, PADU - Preferred, Acceptable, Discouraged, Unacceptable file.
• Other duties as assigned.

Qualified Candidates will:

• High School Diploma with a minimum of 15 years of experience required.
• Associate or Bachelor Degree preferred.

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