Location: Connecticut

Department: Managed Care, Clinical Performance

Reports to: Vice President, Clinical Performance & Marketing

Purpose: The Manager provides leadership and management support to the organization in the strategic areas of managed care and clinical performance.  These strategies must be further enhanced, implemented, and supported through ongoing development of tactical operations/activities and business relationships that advance the clinical, philosophical, and financial objectives of the organization.

In this position, the Manager will support the ongoing evolution of Clients clinical strategy as it prepares for the anticipated impact of changes related to health reform

Key Accountabilities:

Managed Care:
Establish and attain budget/revenue goals related to contracting and clinical performance operations
Assume primary accountability for contract development, financial analysis, negotiation, implementation, and provider relations as relates to ongoing contract management
Coordinate and facilitate the creation and maintenance of long-term business partnerships with health plans
Identify and/or create additional managed care opportunities for continued revenue growth, i.e., shared savings, risk contracts
Develop internal processes and resources to support business relationships and improve efficiency and service
Collaborate with VP of Clinical performance to develop key strategies and programs; participate on ad hoc task forces and committees; and attend POD meetings as necessary
Oversee all reporting related to clinical performance and managed care activities, acting as the key business analyst and liaison to the informatics team to develop and sustain reports required to achieve client's performance objectives

Provider Relations:
•    Communicate key information regarding contract participation/terms to practices, regional managers, etc.
•    Update Central Billing when plans are added/fee schedules are changed
•    Act as liaison between providers/practices & health plans to resolve questions
•    Maintain database of contract and plan participation by physician
•    Maintain all contract fee schedules and summaries 

Clinical Performance:
•    Oversee all reporting related to clinical performance and managed care activities, acting as the key business analyst and liaison to the informatics team to develop and sustain reports required to achieve client's performance objectives
•    Use internal and external data to understand performance and develop appropriate intervention and improvement strategies
•    Serve as lead executive to the Clinical Performance Committee
•    Work with Committee Chair to develop effective communications related to program
•    Monitor provider compliance with program eligibility criteria
•    Analyze year-end results and perform all calculations related to allocation of performance-based incentives
•    Maintain ongoing communication with practices
•    Collaborate with EHR trainers to develop online clinical performance training program

Management Accountabilities:

• Direct reports include:
• Provider relations specialist

Committee Participation:

• Management Team
• Executive Lead – Clinical Performance Committee
• POD meetings – as needed
• Clinical Council

Requirements:

• Minimum of Bachelors degree in a related discipline (Business, Finance, Healthcare Administration); Master’s degree preferred
• Strong experience and current working knowledge of health care environment, systems and reimbursement models
• Developed negotiating skills
• Prior supervisory experience
• Excellent project management and critical thinking skills
• Ability to multi-task a wide variety of initiatives
• Familiarity with clinical terminology and disease states
• Ability to work independently and as part of multidisciplinary teams
• Orientation to both planning and implementation skills
• Advanced experience in healthcare operations
• Analytical thinking related to turning data into information and performance improvement tools