OverviewJoin an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Dallas Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Roxborough Memorial Hospital is a 131-bed community hospital. The hospital has been serving the medical and health care needs of the Roxborough, Manayunk, East Falls and northwest section of Philadelphia communities for more than a century, having first opened its doors in 1890. Roxborough Memorial Hospitals School of Nursing has been educating nurses since 1898. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency. Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOCKnowYourRightsscreenreader1020.pdf Responsibilities This position is remote Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed care agreements in place at all hospital facilities and employed physicians. The Regional Manager effectively interacts with Corporate Executive Management, Hospitals, and Business Office Management and Medicare, Medicaid, exchange and commercial insurance payers. The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; assist in the measurement of payer compliance with contract terms; participate in JOCs; and assist hospital and business office management in resolution of issues related to managed care agreements. This position o ffers a competitive compensation and great benefits. In this role you will be responsible for Negotiation, Contract Managment, Healthcare Agreements, Payer Contracts, Reimbursement Rates and Health Insurance. Involving Medicare/Medicaid, Value-Based Care, Healthcare Laws and Fee Schedules. QualificationsEDUCATION, EXPERIENCE, TRAINING 1. Bachelor of Business/ Health/ Management field or relevant bachelor’s degree 2. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management 3. 5 years of contract negotiation/managed care experience in a hospital or hospital system setting, required 4. Previous behavior health contracting, joint operating committee and C-suite collaboration experience is a plus 5. Business office and claims knowledge and/or experience, preferred 6. Must obtain Sexual Harassment Certification within 6 months, and then maintain biennially. We are looking for someone who has #contractnegotiations in a #managedcare environment. Experience working in #healthcare working with #healthinsurance companies is a must. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176639/regional-manager-managed-care/job?mode=apply&apply=yes&iniframe=1&hashed=-336024306) FacilityRoxborough Memorial HospitalLocationUS-PA-PhiladelphiaID2024-176639CategoryManagerPosition TypeFull TimeShiftDaysJob TypeExempt
