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    Managed Care Manager - Dubai, United Arab Emirates - ClickJobs

    ClickJobs
    ClickJobs Dubai, United Arab Emirates

    1 day ago

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    Description

    Position Summary

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

    Schedule:

    • Flexible, may require some evening and weekends
    • Hours worked per week may exceed 40 hours

    Primary Duties And Responsibilities

    • Directs negotiation of managed care contracts including optimal capitation rates, fee-for-service reimbursements, bonus, incentives and etc.
    • Reviews, negotiates and renegotiates payor contracts including rates and contract language provisions.
    • Develops and maintains a complete library of payor contract documentation for each payor including contract summary documents, copies of all fully-executed contracts with related amendments, letters, policies and other operational reference materials.
    • Initiates, fosters and maintains productive long-term relationships with key payor contacts.
    • Collaborates with other departments to generate quantitative and qualitative data analyses to support negotiations.
    • Interfaces with other divisional managers to ensure operational efficiencies and effective administration of all contractual agreements.
    • Interfaces with internal departments to ensure the completion and submission of contractual documentation to contracted health plans or IPAs. (i.e., provider roster, credentialing information)
    • Ensures capture of incentives based on services provided: 120-day health assessments, timely encounter data submission, HEDIS, CHDP services and etc.
    • Negotiates contractual agreements with IPAs and health plans on specialty services such as OB, Mental Health, CPSP, DM Program and etc. based on fee-for-service model and health care outcomes.
    • Able to create and analyze the productivity and financial reports, make appropriate recommendations and corrective action plans.
    • Assists Operations Director in developing the IPA Network with other community clinics.
    • Partners with Operations Director to ensure compliance as required by Health Plans, IPAs and other regulatory agencies.
    • Participates in organizational meetings as requested.
    • Performs other duties as assigned.

    Minimum Requirements

    • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Access, Outlook)
    • Strong interpersonal and communication skills
    • Ability to interface with all levels of management
    • Effective Prioritization, multi-tasking and follow-up skills
    • Strong attention to details
    • Ability to work as a team player and work independently
    • Reliable transportation
    • Must be able to travel from facility to facility
    • This position requires 10 % travel with frequent travel outside the local area.

    Required Education/Experience And/or Licensure/Certification

    • Knowledgeable of Managed Care and IPA business models
    • Minimum of 5 years' experience in Managed Care with contract negotiations experience;
    • Bachelor's Degree in Finance/Accounting, Business Administration, Public Health, or other related studies strongly preferred and/or equivalent work experience
    • Strong Accounting and Financial background
    • Knowledgeable of Medi-Cal Managed Care and Medicare compliance, HMO's and other regulatory agency guidelines
    • Commitment to goals and philosophy of Northeast Community Clinic
    • Valid State Identification
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