Manager Managed Care Contracting

Overview

BJC HealthCare is a large nonprofit health care organization serving residents in the greater St. Louis, southern Illinois, and southeast Missouri areas. With net revenues of $6.3 billion and over 30,000 employees, BJC operates 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care, and hospice. BJC is the largest provider of charity care and community benefits in Missouri, with annual community benefit expenditures of $785.9 million.

Role Purpose

In collaboration with leadership, the Managed Care Contracting Manager manages and leads the contract negotiations with Managed Care Organizations (MCOs), including rate and language discussions in accordance with established guidelines and aligned with BJC strategic goals. This position develops and maintains strong relationships with MCOs and collaborates with Healthcare Service Organizations (HSOs) to identify challenges and opportunities for improvement around contract performance.

Responsibilities

• Manages individual(s) including onboarding and hiring, training, workload management & performance evaluations, and developing professional development plans as needed.
• Negotiates complex managed care contracts on behalf of BJC HSOs, including hospitals, physicians, home care, behavioral health, and other ancillary providers; leads contract discussions with MCOs, reviews and drafts contract language provisions, and negotiates rates within established guidelines.
• Facilitates problem-solving of identified contractual and operational issues in collaboration with MCOs and internal stakeholders; identifies and communicates opportunities for process improvement with MCOs and internal stakeholders.
• Stays abreast of changing healthcare landscape to maintain 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.
• Collaborates with the analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems.

Minimum Requirements

• Education: Bachelor's Degree
• Experience: 5-10 years
• Supervisor Experience: 2-5 years

Preferred Requirements

• Education: Master's Degree
• Experience: 10+ years
• Supervisor Experience: 5-10 years

Benefits And Legal Statement

BJC Total Rewards offers comprehensive medical, dental, vision, life insurance, and legal services starting on the first day of employment. Disability insurance is provided by BJC. Employees can contribute up to 4% of their salary to the BJC Automatic Retirement Contribution plan, and participate in a 401(k) plan with a company match. Tuition assistance is available. Health Care and Dependent Care Flexible Spending Accounts are offered, along with Paid Time Off combining vacation, sick days, holidays, and personal time. Adoption assistance is also available. For more information, visit our Benefits Summary. Not all benefits apply to all jobs. Equal Opportunity Employer.