- Assists the Managed Care Director with negotiations, for both fees for service & value-based care agreements through the use of financial analysis and contract language reviews.
- Maintains relationships with Payers and works to resolve contract compliance issues by working closely with revenue cycle leadership, to ensure revenue streams are not disrupted.
- Assists the Managed Care Director with the oversight of contracted managed payers.
- Develop and oversee the implementation of strategies to improve managed care performance in terms of utilization, patient access, cost, compliance with contractual quality measures, etc. Align improvement with quality and financial goals.
- Contribute to the management of department staff and employees’ systemic development and success.
- Discuss and develop system policies and procedures.
- Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable policies.
- Other duties as assigned.
- Must understand healthcare contracting including financial analysis, credentialing, legal review, Value Based Care, and utilization data.
- Effective communication skills both written and verbal as well as the ability to exercise judgement when working with individuals with different points of view on a critical issue.
- Excellent presentation and negotiation skills
- Ability to maintain confidentiality of all patient information, per HIPAA requirements.
- Knowledge and high level of proficiency in Microsoft Office software suite.
- Strong interpersonal and leadership skills to lead and direct the Managed Care department.
- Bachelor’s degree from an accredited university.
- Five (5) years of managed care work experience within a health system, managed care organization, or consulting firm.
- Strong leadership and negotiation skills. Knowledge of managed care contracting rates for network providers, services, and facilities.
- Advanced ability to operate computers and related software for Microsoft programs including Word, Excel, Outlook.
- Sound financial acumen and the ability to analyze and interpret financial reports and metrics.
- Proven ability to build and maintain strong relationships with vendors and internal stakeholders.
- Master’s degree in business administration, health administration or finance from an accredited college or university.
• Competitive Salary
• Paid Time Off
• Health, Vision & Dental Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• 401(K)
• Life Insurance
Top Skills
What We Do
Keystone Advisors of Illinois, LLC. (Keystone) specializes in providing Staff Augmentation services in the areas of Financial Management, Program Management, and IT. Established in 2008, our principals have over 30 years’ experience in providing recruiting and Human Resources Services to the DLA and DOD prime contractors.
Keystone has a staff of 4 recruiters and 2 Account managers and our compensation, recruitment and retention policies are designed to attract and retain the best human resources available to assist our clients in meeting their mission critical needs. We currently have 40 people on staff on various positions around the CONUS.
Keystone maintains a proprietary database of over 500,000 potential resources in labor categories such as Program Managers, Financial Managers, and IT Personnel. In addition Keystone is a licensed CPA firm and has Primed Projects involving Program managers and Financial Managers, licensed CPAs, Certified Information Systems Auditors (CISAs), Accountants, IT Specialists and Program Managers who have deep experience in Federal financial statement preparation, Budget and Analyst. We have past performance in working on audit readiness projects with the Navy, Army, Defense Logistics Agency (DLA), and Defense Finance and Accounting Service (DFAS)
