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    Managed Care Manager - Dubai, United Arab Emirates - ClickJobs

    ClickJobs
    ClickJobs Dubai, United Arab Emirates

    1 week ago

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    Description

    PositionSummary

    Underthe direction of the Operations Director and Executive Director,this position is responsible for the negotiation, optimization andthe operational management of the managed care contracts; Medi-Cal,Medicare, Commercial, PPO, FFS andetc.

    Schedule:

    • Flexible, may require some eveningand weekends
    • Hours worked per week may exceed40 hours

    PrimaryDuties AndResponsibilities

    • Directs negotiation of managed carecontracts including optimal capitation rates, fee-for-servicereimbursements, bonus, incentives andetc.
    • Reviews, negotiates and renegotiates payorcontracts including rates and contract languageprovisions.
    • Develops and maintains a completelibrary of payor contract documentation for each payor includingcontract summary documents, copies of all fully-executed contractswith related amendments, letters, policies and other operationalreference materials.
    • Initiates, fosters andmaintains productive long-term relationships with key payorcontacts.
    • Collaborates with other departmentsto generate quantitative and qualitative data analyses to supportnegotiations.
    • Interfaces with other divisionalmanagers to ensure operational efficiencies and effectiveadministration of all contractualagreements.
    • Interfaces with internaldepartments to ensure the completion and submission of contractualdocumentation to contracted health plans or IPAs. (i.e., providerroster, credentialing information)
    • Ensurescapture of incentives based on services provided: 120-day healthassessments, timely encounter data submission, HEDIS, CHDP servicesand etc.
    • Negotiates contractual agreements withIPAs and health plans on specialty services such as OB, MentalHealth, CPSP, DM Program and etc. based on fee-for-service modeland health care outcomes.
    • Able to create andanalyze the productivity and financial reports, make appropriaterecommendations and corrective actionplans.
    • Assists Operations Director indeveloping the IPA Network with other communityclinics.
    • Partners with Operations Director toensure compliance as required by Health Plans, IPAs and otherregulatory agencies.
    • Participates inorganizational meetings as requested.
    • Performsother duties as assigned.

    MinimumRequirements

    • Proficiency in Microsoft Officeapplications (Word, Excel, PowerPoint, Access,Outlook)
    • Strong interpersonal and communicationskills
    • Ability to interface with all levels ofmanagement
    • Effective Prioritization,multi-tasking and follow-up skills
    • Strongattention to details
    • Ability to work as a teamplayer and work independently
    • Reliabletransportation
    • Must be able to travel fromfacility to facility
    • This position requires 10% travel with frequent travel outside the local area.

    RequiredEducation/Experience And/orLicensure/Certification

    • Knowledgeable of Managed Care and IPAbusiness models
    • Minimum of 5 years'experience in Managed Care with contract negotiationsexperience;
    • Bachelor's Degree inFinance/Accounting, Business Administration, Public Health, orother related studies strongly preferred and/or equivalent workexperience
    • Strong Accounting and Financialbackground
    • Knowledgeable of Medi-Cal ManagedCare and Medicare compliance, HMO's and other regulatoryagency guidelines
    • Commitment to goals andphilosophy of Northeast Community Clinic
    • ValidState Identification
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