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Regional Managed Care Manager (Contracting & Network Development)

Richardson, TX · Healthcare
The primary responsibility of the Regional Manager, Managed Care position is to evaluate, negotiate, and secure agreement to new and existing contracts with third party payors, including commercial health plans and managed medicaid payors. Responsibilities include, but are not limited to; leading and negotiating third party payor negotiations, reviewing and reaching agreement with payors on contract language, acquisition integrations, overseeing resolution of contract payment issues, analyzing contract performance, assisting in collection efforts, and public policy initiatives.

  • Bachelor’s degree or 5+ years related experience and/or training; or equivalent combination of education and experience.
  • 5+ years experience with managed care including payor or provider contracting background.
  • Significant experience negotiating managed care contracts with third party payors
  • regarding physician professional service compensation issues; experience with fee schedule, case rate, per diem, and capitation reimbursement; familiar with patient accounting tasks including billing, collections, and reimbursement analysis.
  • Excellent written and verbal skills; negotiation skills, computer proficiency (Excel and various software programs, data report writers.
  • Strong analytical and quantitative skills for the development of reimbursement proposals.

April A. Estes
ProEnlist, LLC
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Please do NOT email the recruiter.  Applications are only accepted via the apply link.
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