Position Summary
The Contracts Manager, Managed Care is the subject matter expert on all managed care contract terms and conditions and has primary responsibility for negotiation, implementation and performance review of assigned managed care contracts.
Contracting may include Phoenix Children s Hospital, Phoenix Children s Medical Group, Phoenix Children s Care Network and all related entities.
Position Duties
Oversees the contract management cycle. Leads and has primary responsibility for high-profile contracts, as assigned, on an ongoing basis.
Initiates and oversees pre-negotiation activities including model preparation, market analysis, contract language and rate negotiations, contract implementation, and contract performance phases within specified time periods.
Leads the development of contract proposals for negotiations. Identifies opportunities for contract improvement by tracking issues prior to negotiations and obtaining input from key areas, including;
Pre-Access, Revenue Cycle, Legal, etc. . Provides leadership with alternative strategies as well as recommendations for financial and operational improvements.
Leads contract negotiations with Payers on behalf of Phoenix Children s. Initiates contract discussions with Payers, including;
contract language and rate negotiations. Effectively collaborates with management, legal, analytics, clinical, operations, and administrative teams to ensure successful contract negotiations are undertaken in a cost effective manner and contract negotiations are completed in accordance with critical dates and within approved financial parameters.
Ensures contract language reflects approved contract terms and conditions.
Effectively manages payer contract relationships. Serves as the lead and primary contact for payers as well as internal staff at all levels, including leadership.
Establishes and maintains positive working relationships with payer contacts. Maintains open lines of communication between Phoenix Children s and health plans or payers.
Facilitates collaborative discussions for problem solving. Communicates opportunities for process improvement.
Reports on status of payer contracts and negotiations. Maintains current contract status and negotiation status in Contract Management system and other prescribed documents.
Prepares status reports or dashboards as specified in Managed Care documentation. Prepares and distributes Executive Summary and other necessary documentation / notifications upon completion of contract negotiations.
Acts as subject matter expert for all matters related to payer contracts. Stays abreast of changing health care landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts.
Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
Stays abreast of payer fee schedule and policy changes. Effectively interfaces with other team members to ensure contract terms, rates, conditions, and policies are clearly understood.
Facilitates securing information needed for fact-based decision-making.
Performs miscellaneous job related duties as requested.
Phoenix Children's Mission, Vision, & Values
Mission
To advance hope, healing and the best healthcare for children and their families
Vision
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by :
- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families
Values
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable
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