Responsibilities Manager -Payer Strategies (Acute) (Nevada Market) This role is focused on the tactical execution, administration and maintenance of hospital and physician managed care contracts and offers guidance on rate proposals and negotiation approaches. This position manages the full contract negotiation cycle for assigned contracts, focusing on specific financial reimbursement terms, rates, and language. Coordinates the implementation of new or renegotiated contracts within the organization and ensures compliance with contract terms and collaborates with the internal stakeholders to monitor payment accuracy and contract performance. This position serves as subject matter expert on contract specifics for the revenue cycle team and case management teams. This position serves as a primary point of contact for routine payer-related issues, disputes, and information sharing, fostering functional relationships with internal stakeholders and payer representatives. Works closely with finance and data analytics teams to provide support for negotiations and to monitor contract performance metrics) to support the organization’s managed care strategy. Develops strategies for contract relationships and negotiations. Responds to market opportunities and monitors significant market changes to protect and enhance market share for the UHS-NV Region. Analyzes the significance and value of potential contracts. Determines the cost of care based on care delivery and contract structure. Projects contract performance based on modeling of actual and representative samples. Develops contract language to protect UHS-NV Region’s best interest and satisfy strategic contracting objectives. Reviews and revises language templates and counter proposal language for Health Plans. Ensures that terms meet the financial and operational needs of UHS-NV Region. Develops structures that are appropriate to the institution. Includes full range of reimbursement structures whether hospital, physician, ASC, bundled payments, capitation, etc. Considers cost of care or performance targets in relation to the size and scope of the contract. Develops and analyzes rates for proposals or counter proposals. Serves as a liaison and knowledge resource to Revenue Cycle and other Operational Departments regarding ongoing contract compliance to support key business functions and contribute to continual improvement. Analyzes and monitors contract requirements, special provisions, terms, and conditions to ensure compliance with appropriate laws, regulations and UHS-NV Regional policies and business procedures. Determines how the Contracting Department can assist with processes, communication, and interpretation of language for Revenue Cycle and other Operational Departments. Engages in preparation and planning of annual renegotiations. Reviews and develops contract language, maintains historical records of payor/contract information. Participates in negotiation strategy. Offers suggestions to Regional and Corporate leadership for changing future contracts based on review of existing contracts. Establishes and implements a consistent schedule of Joint Operations Committee (JOC) meetings with key payors. Addresses contract performance, including, but not limited to, revenue cycle, utilization management, as well as other operational issues. Works with key internal and external stakeholders to establish JOC Meeting agenda and leads them as required. Provides ongoing analysis and reporting on existing contracts for compliance, performance reviews, net revenue budgeting, long-range planning, and survey responses. Studies historical utilization and trends in revenues through financial data. Identifies issues with the operation of contracts. Updates the Regional Director of Managed Care and Payer Strategies on unexpected changes in the planned performance of contracts. Produces operational statistical reports to provide contracting team with tools for strategy and decision making. Monitors contract payments and reviews them for accuracy of package rates and volume of services by payor. Shares information with contracting staff for use during renegotiations. Addresses operational issues with payers by proactively identifying issues and soliciting information and feedback on implementation of performance contracts from Revenue Cycle Management. Prepares Payor Scorecards for Revenue Cycle for use during contract negotiations. Develops tools and procedures, such as information grids on contract terms/fiscal summaries, payment reports, etc. for use by various operational departments. Develops standard reports and maintains skills for ad hoc reporting needs. Provides these process mechanisms to ensure timely updates on renewals, amendments and other contract changes that need to be communicated and to disseminate information for appropriate audiences. Manages contract software and dataset tools that populate contract rate grids. Ensures final documents include all necessary UHS-NV Regional terms and conditions. Provides improvements and updates to templates Manages specific projects/committees or represents specific entities as needed. Develops expertise in rate requirements and contract language. Creates strategic plans. Serves as a point person for operational issues. Develops and maintains effective working relationships with key leaders such as IPM Physicians, IPM and Hospital Operations, Department Administrations, Health Plans, Corporate and Regional leaders, and other internal and external staff involved in the contract process. Mentors the Contracting Department staff and assists with training as needed. Attends team meetings and participates in discussions and strategic initiatives. Provides back up as needed for the department directors. Performs other duties as assigned/required. Qualifications
Bachelor’s degree in finance, Business/Economics, Healthcare Administration, or a related field. Master’s Degree preferred.
A minimum of five years of experience in a healthcare organization, or within the health insurance industry, working with provider network development, provider relations, billing cycle and contract negotiations is required.
Experience in a large healthcare organization or academic medical center is preferred.
Proven track record in contract negotiations.
Advanced computer operation competency with the ability to utilize spreadsheet, word processing, calendar, and email applications effectively. Windows PC environment is preferred.
Practiced in managed care database development, management, and navigation.
Negotiation expertise along with acumen to achieve stretch goals in difficult circumstances.
Disciplined in handling challenging communication professionally.
Ability to work across organizations and represent physicians and hospital interests. Polished interpersonal relation skills promoting teamwork and collaborative alliances.
Excellent organization, time management and problem-solving skills with the capacity to meet deadlines while managing multiple tasks.
Adept at tracking, editing, and monitoring complex contracts with multiple language changes and addenda.
Detailed in the attention to language and rate structures in contracts.
Effective written and verbal communication skills. Travel: Up to 5% US or internationally travel This opportunity offers the following: Challenging and rewarding work environment Growth and Development Opportunities within UHS and its Subsidiaries Competitive Compensation Excellent Medical, Dental, Vision and Prescription Drug Plan 401k plan with company match Generous Paid Time Off About Universal Health Services Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed n
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