Junior Contract Manager
Junior Contract Manager-1700909
The Managed Care Department of Stony Brook Medicine seeks a Junior Hospital Contract Manager with the skills and competency to assist the Senior Contract Manager in the negotiation of managed care contracts with health plans and payers, which includes pay-for-performance programs, and to monitor revenue to ensure that Stony Brook University Hospital and its affiliated academic physician practice plans meet their corporate contracting goals in terms of financial performance. Demonstrated provider, health insurer and/or health plan experience in hospital managed care contract negotiations and pay-for-performance programs is required, and with physician managed care contract negotiations is preferred. The successful candidate will have the ability and skill set to work independently with only limited supervision
Duties of a Junior Contract Manager may include the following but are not limited to:
- Assist Senior Contract Managers in the development of financially advantageous managed care compensation proposals by accurate analysis of utilization, demographic, case mix and market share data.
- Assist in negotiating managed care agreements on behalf of Stony Brook University Hospital and the Stony Brook Medicine faculty practices.
- As directed, prepare reports and presentations on managed care utilization, trends and financial impact.
- As directed, facilitate the implementation of managed care products such as hospital, physician and non-physician clinical networks and integrated delivery systems.
- Review and disseminate health insurer/plan policies and operating procedures to Stony Brook Medicine constituencies and provide education and support resources for the accurate implementation of same.
- Work with representatives from health plans and payers, the clinical practice plans, the Director of Managed Care and legal counsel to ensure that contractual arrangements are adhered to, and that payer and hospital needs are met. Assist in the facilitating of monthly liaison meetings with health plan representatives (usually referred to as “joint operating committees”) and provide input and give feedback regarding contracting issues. Analyze claims pre and post payment to ensure that contracts and reimbursement policies and procedures are adhered to. Review claim disputes to verify correct coding and billing. If systematic errors are uncovered, recommend system changes, as well as training and process improvements, to prevent future errors. As necessary, provide the Senior Contract Manager and/or the Director of Managed Care and other staff with information that may have a positive and/or negative effect on revenue.
- Nurture relationships with existing payer contacts, as well as hospital, faculty/administrative staff and CPMP employees, to support the health systems objectives.
- Maintain a familiar working knowledge of payer benefit plans, policies and procedures, and in consultation with the Senior Contract Manager interpret and distribute this information to clinical practice plan employees. Assist the Director of Managed Care and the Senior Contract Manager in the development and maintenance of a “Managed Care Handbook” for hospital, clinical practices and academic faculty staff and annually, or more frequently if needed, update and disseminate same to all concerned parties.
- Provide guidance and support to lower level staff. Triage and independently resolve referred managed care issues and, if necessary, escalate complex problems to the Senior Contract Manager. Maintain key enrollment and contract management information and assist the Senior Contract Manager in providing the Director with timely and accurate reports of all business activity.
Bachelor's degree. Minimum of one (1) year of experience in a managed care organization with emphasis on network development. Candidate must demonstrate project management skills and be proficient in database management. Demonstrable background in healthcare policy and management. Position requires contracting/negotiating, interpersonal and quantitative skills.
Preferred Qualifications: MBA, MHP, MPA or equivalent advanced degree. Experience with both health insurers/plans and health care providers, particularly academic medical centers. Experience in the development, implementation and administration of managed care agreements. Experience with monitoring of financial performance of manged care agreements and health care claims billing and payment.
Special Notes: Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
This function/position has been designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at email@example.com.
About Stony Brook Medicine:
The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients’ lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island’s premier academic medical center. With 603 beds, we serve as the region’s only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children’s Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center.
Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.
IF YOU NEED A DISABILITY-RELATED ACCOMMODATION, PLEASE CALL THE UNIVERSITY HUMAN RESOURCE SERVICES DEPARTMENT AT (631) 632-6161 OR THE UNIVERSITY HOSPITAL HUMAN RESOURCES DEPARTMENT AT (631) 444-4700.
IN ACCORDANCE WITH THE TITLE II CRIME AWARENESS AND SECURITY ACT, A COPY OF OUR CRIME STATISTICS IS AVAILABLE UPON REQUEST BY CALLING (631) 632-6350. IT CAN ALSO BE VIEWED ON-LINE AT THE UNIVERSITY POLICE WEBSITE AT http://www.stonybrook.edu/police
Official Job Title: TH Senior Staff Assistant
Job Field: Administrative & Professional (non-Clinical)
Primary Location: US-NY-Stony Brook
Department/Hiring Area: Managed Care-Stony Brook University Hospital
Schedule: Full-time Day Shift 8:30 am to 5:00 pmManaged Care-Stony Brook University Hospital
Posting Start Date: May 4, 2017
Posting End Date: Jun 3, 2017, 10:59:00 PM
Salary: $90,000 - $110,000
Salary Grade: SL3