Contract Manager Managed Care

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Contract Manager Managed Care

Location

Cleveland

Facility

Remote Location

Department

Ohio Market Finance-Finance

Job Code

T3110E

Shift

Days

Schedule

8:00am-5:00pm

Job Summary

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

As a Contract Manager Managed Care, you will negotiate and renegotiate managed care contracts while overseeing and coordinating the administrative, legal, operational and financial issues related to contract negotiations. In this role, you will maintain a comprehensive payer and managed care intelligence database, develop responses to requests for proposals from managed care plans and facilitate the creation of managed care educational and training materials for payer contract services, physicians, office managers and other participating provider personnel.

A caregiver in this position works remotely from 8:00 a.m. -- 5:00 p.m. and is required to meet with the team annually in Cleveland for a half-day, on-site meeting.

To be considered for this role, candidates must reside in Ohio, Florida or Nevada.

A caregiver who excels in this role will:  

• Manage a defined range of payer agreements such as PPO's, ancillary agreements, physician contracts or other managed care agreements.
• Routinely update rates and contract terms.
• Assemble, coordinate and manage the contract negotiation team including legal, finance, payer contract services and operations.
• Prepare assessments of new payer relationships including a comparison of standard CCHS terms and contract objectives.
• Recommend updates to standard CCHS contracts and business terms as business environment dictates and strategies change.
• Propose alternate legal language.
• Coordinate contract changes suggested by CPP, hospitals, legal, risk, and UM/QA.
• Evaluate opportunities and financial terms for hospital and physician contracts.
• Maintain chronology of managed care proposals and counter proposals.
• Assess legal risks in the context of contract provisions.
• Draft responses and fulfill requests for additional information needed by managed care plans representatives.
• Complete the development of proposals in response to managed care plan request for proposals.
• Provide the strategic and financial judgment necessary to achieve profitable growth with payers.
• Review models that quantitatively evaluate the financial impact of proposals to hospital and physician practice managers.
• Support and participate in the continuous assessment and improvement of the quality of care and services provided.
• Participate in the development of the annual budget and assist in developing contracting goals, strategies, activity plans and projections.
• Work with marketing department to develop and promote new products as well as build revenue in existing products.
• Other duties as assigned.

Minimum qualifications for the ideal future caregiver include:  

• Bachelor's Degree
• Three years of contracting experience in a payor, provider or other relevant contract setting including negotiation of financial/contract terms and development of contract language
• Working knowledge of leading-edge managed care methodologies and practices
• Working knowledge of managed care operations, physician office practices, as well as hospital admitting, billing, and utilization review operation
• Negotiation skills, outstanding analytical ability and financial skills
• PC skills necessary with experience in Microsoft Office products
• Managed care experience
• Experience across multiple service lines (e.g., heart and vascular, transplant, women’s health).
• Health system–based managed care contracting experience
• Hands-on experience negotiating and managing health insurance contracts

Preferred qualifications for the ideal future caregiver include:

• Master's Degree with a focus in healthcare finance, marketing, administration or related field
• Background involving managed care contracting with health systems to include hospital, professional, ancillary services
• Experienced with Fee for Service and Value Based negotiations for Commercial, Medicaid, Medicare Advantage and Marketplace plan types
• Understanding of Revenue Cycle and Managed Care Business Operations

Physical Requirements:

• Ability to communicate and exchange accurate information. 
• Ability to perform work in a stationary position for extended periods.  
• Ability to work with physical records or operate a computer or other office equipment.  
• In some locations, ability to travel throughout the hospital system.  
• In some locations ability to move up to 25 lbs.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster. 

Cleveland Clinic is pleased to be an equal employment opportunity employer.