Contract Manager - Managed Care (Finance)

Primary Functions:

Nemours Children's Hospital, Florida is seeking a Contract Manager - Managed Care (Hybrid) (FULL-TIME), to join our team in Jacksonville, FL.

This position is responsible for the coordination of crafting, evaluating, and execution of contractual negotiations, as directed by the director, which includes contract performance overview and analysis, and language review for hospital, specialist, primary care and urgent care agreements. Contractual negotiations include, but not limited to, fee-for-service, capitated, Clinically Integrated Networks, Value-Base Pay for Performance and Risk agreements. This position works directly with Managed Care's leadership during negotiations.

This position also manages the payer contractual relationship and functions as a liaison between the Managed Care Organizations (MCO'S) and The Nemours Foundation and affiliates.

Essential Functions:

• Work with interdepartmental team members to analyze rate proposals from and to MCO's and offer direction and recommendations to management during negotiations.
• Monitor contracts and move forward with close-out, termination, extension or renewal according to strategy.
• Solve or investigate any contract-related problems that may arise with other parties and internally with Nemours.
• Research and provide answers to contractual questions posed by various departments within Nemours.
• Work with internal staff to assemble and analyze audit reports to ensure the accurate development and maintenance of provider networks and reimbursement contracts, and compliance by the MCO's.
• Communicate and present information to stakeholders about all contract-related matters.
• Support the Provider Enrollment management and staff to aid if needed on lowering enrollment timelines.
• Negotiate rates and language on single case agreements and track all via spreadsheet.
• Maintain records for correspondence and documentation in relation to established contract and those in progress.
• Review risk contract models and agreements as needed.
• Responsible for supporting the Provider Enrollment Management Team on negotiating Delegated Agreements.
• Notify MCO's of annual charge master increases and any other material changes within Nemours, and work with the MCO's to implement necessary changes or updates (e.g., payment discounts, etc.).
• Work cohesively with other areas of the Managed Care Department to identify and resolve provider, network, and contractual issues, as they arise. Build and foster positive working relationships with contracted and non-contracted MCO's, as well as various departments within Nemours' own organization.
• Provide regular updates to management of the status of contractual compliance of participating MCO's and keeping management apprised of non-contracted MCO's.
• Maintain managed care files such as but not limited to rate grid, contract calendar, Teamshare files, updates, PADU - Preferred, Acceptable, Discouraged, Unacceptable file.
• Other duties as assigned.

Qualified Candidates will:

• High School Diploma with a minimum of 15 years of experience required.
• Associate or Bachelor Degree preferred.

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About Us

Nemours Children's Health is an internationally recognized children's health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we're on a journey to discover better ways of approaching children's health. Putting as much focus on prevention as cures and working hand in hand with the community to make every child's world a place to thrive. It's a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All of our associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

To learn more about Nemours Children's and how we go well beyond medicine, visit us at www.nemours.org .