Regional Manager - Managed Care
Overview:
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Dallas Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Dallas Medical Center is a 155-bed acute care hospital accredited by The Joint Commission that offers a wide range of medical services, including 24/7 emergency care, cardiology, wound care, surgical services, cardiac catheterization lab, and outpatient therapy.The hospital is the only trauma center in the vicinity and is also a Certified Chest Pain Center. Dallas Medical Center is a recipient of multiple Healthgrades Patient Safety Excellence Awards and eight Healthgrades Five-Star ratings over the past three years.
For more information, visit www.dallasmedcenter.com.
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws.The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Responsibilities:
*** This position is remote ***
Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed care agreements in place at all hospital facilities and employed physicians. The Regional Manager effectively interacts with Corporate Executive Management, Hospitals, and Business Office Management and Medicare, Medicaid, exchange and commercial insurance payers.The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; assist in the measurement of payer compliance with contract terms; participate in JOCs; and assist hospital and business office management in resolution of issues related to managed care agreements.
This position offers a competitive compensation and great benefits.
In this role you will be responsible for Negotiation, Contract Managment, Healthcare Agreements, Payer Contracts, Reimbursement Rates and Health Insurance. Involving Medicare/Medicaid, Value-Based Care, Healthcare Laws and Fee Schedules.
Qualifications:
EDUCATION, EXPERIENCE, TRAINING- Bachelor of Business/ Health/ Management field or relevant bachelor’s degree
- Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management
- 5 years of contract negotiation/managed care experience in a hospital or hospital system setting, required
- Previous behavior health contracting, joint operating committee and C-suite collaboration experience is a plus
- Business office and claims knowledge and/or experience, preferred
- Must obtain Sexual Harassment Certification within 6 months, and then maintain biennially.
We are looking for someone who has #contractnegotiations in a #managedcare environment. Experience working in #healthcare working with #healthinsurance companies is a must.