Bachelor’s degree in business, health care or related field; or an Associate degree with two years of managed care experience; or a high school diploma with four years of managed care experience., Five years of experience in contracting or networking within a managed care organization, Health Plan, PHO, PO or similar organization is required., Preferred qualifications include a Master’s degree in health care management, finance or related field and two years of experience with plan and provider contracting., Strong understanding of managed care contracts and negotiation processes is essential..
Key responsabilities:
Act as a liaison between contracted Health Plans and McLaren Physician Partners, ensuring effective communication and collaboration.
Lead negotiations and coordinate contract workflow for assigned plans, reviewing contract language and addressing areas of concern.
Facilitate problem-solving for escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders.
Conduct contract modeling and analysis to support organizational contracting strategies and educate impacted parties on changes in payer policies.
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McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $6 billion (budget FY21), fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 15 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering approximately 640,000 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S.
As part of its Graduate Medical Education (GME) program, McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Medical University. McLaren’s six (6) GME campuses offer 27 residencies and eight (8) fellowship programs that train over 650 future physicians annually. All GME programs at McLaren are overseen and managed centrally by the Department of Academic Affairs.
We are looking for a Contract Administrator to join us in leading our organization forward.
McLaren Health Care is one of Michigan's fastest growing health systems. With 13 hospitals, annual revenues of over $6 billion, and a service area that covers 75% of the state of Michigan, McLaren is committed to the highest levels of patient care.
McLaren Physician Partners is a joint venture partnership between the McLaren healthcare System and our Physician members. Our focus is to support physician offices in all aspects of care delivery and operations including clinical integration, contracting, quality, care coordination and care management, across all settings.
To learn more about MPP please visit www.mclaren.org/mclaren-physician-partners
Position Summary:
Responsible for assisting the Leadership Team in all aspects of Third-Party Payor contracting activities within all market segments for McLaren Physician Partners (MPP), McLaren High Performance Network (MHPN), McLaren Health Care Corporation (MHCC), and its subsidiaries.Maintains an understanding of the impact negotiations have on population health and value-based contracting. Professionally and effectively communicates the advantages of contracting with McLaren, provides ongoing expertise throughout the contracting process and administration of payor agreements.Key team resource to the Leadership Team.
Essential Functions and Responsibilities:
Acts as liaison between contracted Health Plans and MPP, MHPN, MHCC and subsidiaries.
Maintains organizational documents for educating appropriate subsidiaries on managed care contracts, including but not limited to contract database and matrixes.
Collaborates with the team on implementation of Corporate Initiatives, including but not limited to new or expanded services.
Leads negotiations and coordinates contract workflow for assigned plans .
Reviews contract language, redlining documents and evaluating areas of concern, as needed.
Facilitates problem solving of escalated contractual, payor policy and operational issues through collaboration with managed care organizations and internal stakeholders.
Facilitates Joint Operating Committee (JOC) meetings and related tasks with each payor or as required by contract.
Conducts contract modeling and analysis for facility and physician contract rate proposals to support organization contracting strategies.
Analyzes changes in payer policies, rules and regulations impacting both facility and physician payments. Communicates and educates those impacted, as necessary.
This position is fully remote.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
QUALIFICATIONS:
Required:
Bachelor’s degree in business, health care or related field; or an Associate degree and two (2) years’ experience in managed care; or a high school diploma or equivalent and four (4) years’ experience in managed care.
An additional five (5) years’ experience in contracting or networking in a managed care organization, Health Plan, PHO, PO or similar organization.
Preferred:
Master’s degree in health care management, finance or related field.
Two (2) years’ experience with plan and provider contracting with both Facility and Professional.
Additional Information
Schedule: Full-time
Requisition ID: 25000489
Daily Work Times: 8:30-5:00
Hours Per Pay Period: 80
On Call: No
Weekends: No
Required profile
Experience
Spoken language(s):
English
Check out the description to know which languages are mandatory.