American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, and Mississippi, with planned expansion into other states in 2021. For more information, visit AmHealthPlans.com.
The Hospital Contracting Manager will analyze assigned market needs, perform contracting functions with the focus being on hospitals and health systems (IPAs, PHOs). This position will also educate providers and provider service entities, maintain business relationships for the Health Plan(s), report on provider and market changes, and act as a support for other service areas for the Health Plan(s).
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
- Specific focus on the contracting of hospitals and health systems (IPAs, PHOs), in I-SNP markets
- Manage the negotiation and contracting facilities, providers and essential vendors to maintain CMS adequacy and provide necessary services in the care of the Plan members
- Develop and maintain healthcare provider network in assigned region including contracting, credentialing, and educating on expectations and future activities
- Ensure providers and essential vendors meet the credentialing requirements for their appropriate service lines
- Educate providers on the overview of Health Plan(s) functions and roles in caring for its membership
- Analyze the Health Plan(s) provider network to maintain network adequacy on an ongoing basis
- Understand, educate, and discuss basic financial analysis of current or potential contracts and payment arrangements with providers and their appropriate staff
- Work with and be involved in implementation as needed
- Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
- Complete corporate assignments as assigned
- Must be fluent in all current provider payment methodologies
- Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
- Must have strong negotiation, organization, presentation, and time management skills
- Must be able to work effectively in a team environment
- Independent discretion/decision making
- Bachelor's degree preferred with, but not required, emphasis in Healthcare Administration/related field or three years of experience in managed care network development/network services
- Experience in the health care field required
- Prior experience in network development / network services is required
- Prior experience with acute and post-acute facilities is beneficial
- Prior experience with Medicare Advantage plans is helpful
- Does not have supervisory responsibilities
EQUAL OPPORTUNITY EMPLOYER
Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.
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