This position is responsible for leading managed care strategy development and/or implementation, negotiations, management and implementation of the Hospital Organization, Physician Organization, PHO and CIO managed care contracting process for the SSM Health WI region.
Takes forward managed care contracts within SSM Health in order to build consensus with regional MCC committees on direction and subsequently negotiate with payor executives to conclusion. Managed Care Contracts negotiated include traditional fee-for-service and value based contracts with commercial, Medicare Advantage, Medicaid HMO, Tricare and direct to employer payors.
Responsible for the overall operations and performance of SSM Health's PHO and SSM Managed Care Organization, which includes network development, data base management and overall direction.
Reports to: VP Network Management and Group Product Segment Leader
Supervises: Sr Regional Business A/R Contract Payment Analyst
Interrelationships: Internal relationships within SSM: Hospital executives, Network executives, care delivery campus executives, financial executives. Outside relationships include the managed care plan executives as well outside consultants as appropriate.
Imparts the philosophy, values, mission and vision of SSM Health Care and facilitates the integration of values in CQI.
Understands, embraces and practices the principles of CQI in utilizing the Malcolm Baldrige criteria as a means to achieve performance excellence.
Understands, embraces and models the SSMHC leadership competencies and exceptional service standards.
Leads and oversees negotiation of managed care payor contracts for SSM/MCO provider entities in the SSM Health WI Region. Fosters good working relationships with managed care plan executives to ensure good communication and results for SSM Health.
Leads and attends meetings including but not limited to MCC Regional Managed Care Contracting committees; CIO Board and Payor Relations Committees; MCO Board of Directors; MCO Staff and other ad hoc as appropriate
Implements process improvements with the MCO Operations, Managed Care Contracting Process, and other areas of SSM Health as appropriate
Leads Strategic Initiatives that affect the managed care contracting process (i.e. new services to be added to contracts or additional provider sites)
Responsible for staying up to date on managed care trends and make recommendations to SSM Health’s Managed Care Organization in anticipation of or in response to changing managed care environment
Assists others as appropriate
Minimum Professional Education:
• Master’s degree in business administration, management or a related field, preferably with a course concentration in finance or health care
• Eight to ten years of progressive experience with managed care environment; experience in contract negotiations; work with Commercial, Medicare Advantage, Medicaid HMO, TriCare and Direct to Employer
• Five years of management experience.
• Experience in managing projects involving the collaboration, motivation and cooperation of a wide variety of people with whom there is no direct reporting relationship.
1. Understanding the Mission and Values of SSM Health and the Franciscan Sisters of Mary.
2. Ability and desire to integrate CQI principles and tools into work processes.
1. Normal office environment with adequate lighting and ventilation.
2. Ability to adapt to changing situations and set priorities.
Established in 1983, Dean Health Plan is the insurance services subsidiary of Dean and SSM Health. It maintains a position of leadership in insurance services through a physician-led integrated health system that improves the health of its members and delivers a superior level of service and care. We're looking for talented individuals committed to improving the health of our community through inn...ovation, partnership and integrity.
Dean Health Plan holds an Excellent Accreditation -- the highest accreditation available -- from the National Committee for Quality Assurance for its commercial HMO product and has received the Best of Business Award from Corporate Wisconsin for the past four years. It also earned the Welcoa Platinum Workplace Award, which recognizes our high level of commitment to the health and well-being of more than 600 employees and their families. Our West Side office is only blocks away from walking paths, shopping and restaurants at Greenway Station and a weekly farmers'? market in the warmer months.
For more information, visit us at deancare.com/health-insurance