Operations Manager, Managed Care

Position Summary

The Operations Manager, Managed Care is responsible for the day-to-day operations of the PHO’s governmental and managed care contracts to help position the network physicians strongly with new programs, networks and relationships. They will be deeply involved in the analysis, initiation, operations, development, and implementation of key governmental and managed care programs which will continue to enhance Silver Cross’ position in the marketplace and have responsibility for the overall management of the Silver Cross Health Connection.

Essential Duties and Responsibilities

• Run day to day operations that will help enhance and expand revenues for the Hospital through contracts with commercial and governmental payors.
• Implement and manage utilization management, quality and risk coding program.
• Identify ways to offer gain sharing opportunities to network physicians and steps to implement programs.
• Proactively communicate and create strong relationships with physicians, colleagues, and payor contacts.
• Position Silver Cross Hospital and Silver Cross PHO as a top Performer and gain access to “first to market opportunities.
• Implement strategy for network development inclusive of but not limited to provider relations, credentialing, and network management of the PHO and EHP.
• Evaluate opportunities and make recommendations to physicians and senior management.
• Integrate pricing, contracting and program development strategies to maximize volume and profitability.
• Align and maintain portfolio of contacts to assure consistency and sustainability.
• Review contracts annually, for both the Hospital and PHO, and execute appropriate management strategies to ensure profitability.
• Provide overall management and guidance for the PHO’s vendor partnerships.
• Enhance and develop clinical integration and financial integration programs for network physicians and manage the PHO’s regulatory compliance of the programs.

Required Qualifications

• 10 years’ experience in healthcare at commercial payors, hospitals or consulting firms
• Bachelors degree in Business Administration or related field required
• Significant experience contracting and population health programs
• Experience with Medicare Advantage
• Direct Contracting with Large employers preferred
• Working with physician organizations