Contract Mgr. II - health plans

Overview

BJC HealthCare is a large nonprofit health care organization serving residents in the St. Louis, southern Illinois, and southeast Missouri regions. With over 30,000 employees and annual net revenues of $6.3 billion, BJC delivers a wide range of services including hospitals, community health centers, and various wellness programs. BJC is known for its commitment to community benefits, offering $785.9 million annually in charity care and community benefits.

Responsibilities

• Manages the negotiation, implementation, and ongoing evaluation of designated managed care arrangements.
• Ensures access for patients and secure reimbursement for the hospital through the Single Case Agreement (SCA) process.
• Facilitates contract negotiations with tier 1 Managed Care Organizations (MCOs) for hospital, physician, ancillary, and credentialing agreements.
• Maintains close partnerships with managed care finance and the value-based care team to ensure agreements reflect accurate rates and provisions.
• Collaborates with internal stakeholders to implement strategy and participate in key internal meetings.
• Participates in problem-solving of escalated contractual and operational issues through collaboration with MCOs and internal stakeholders.
• Educates Healthcare System Operations (HSO) on contract provisions and collaborates with Provider Relations on operational issues.

Requirements

• Preferred Qualifications: Bachelor's degree, 5-10 years of experience in managed care contracting, and supervisor experience.