Job Abstract

It's more than a career, it's a calling.

Worker Type:

Job Highlights:

PRIMARY RESPONSIBILITIES

• Develops and implements strategic and operational goals and objectives. Ensures policies and procedures are current and in compliance with applicable regulations and standards. Makes recommendations based on changes and trends in the area of managed care, reimbursement and applicable state and federal regulatory environment.
• Provides mechanisms to solicit feedback on payer performance, departmental needs and satisfaction with payer services in designated areas of responsibility.  Ensures problems, complaints and deficiencies with payers are investigated and appropriate actions taken.
• Develops and evaluates departmental and payer benchmark key performance indicators and major processes.  Provides reports and recommendations to senior management.
• Oversees the development, negotiation, implementation, monitoring and management of all managed care agreements.
• Negotiates and reviews direct employer payer contracts. Directs financial modeling specific to contracting efforts, ensuring negotiated rates meet desired objectives.
• Analyzes and interprets system-wide analytical information and providing system and local level leadership with insightful observations and action plans to address trends.
• Serves as network contact for managed care contracting functions.  Provides resolution to managed care contractual issues pertaining to contract interpretation and coding with payers.
• Performs other duties as assigned.

EDUCATION

• Bachelor's degree, or equivalent years of education and experience 

EXPERIENCE

• Seven years' experience, with five years' in leadership

Named 150 Top Places to Work in Healthcare 2023 - Becker's Healthcare

Named One of America's Greatest Workplaces for Diversity 2023 - Newsweek

Named One of America's Greatest Workplaces for Women 2023 - Newsweek

SSM Health is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health care delivery system. The organization’s 40,000 team members and more than 12,800 providers are committed to providing exceptional health care services and revealing God’s healing presence to everyone they serve.
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With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes 23 hospitals, more than 300 physician offices and other outpatient and virtual care services, 13 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves.

To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:

Angela Jones

Executive Talent Acquisition

Angela.Jones1@ssmhealth.com

SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.

#LI-Onsit

Job Summary:

Job Responsibilities and Requirements:

Directs managed care activities and resources.  Monitors and reports financial performance of managed care contracts.

Department:

Work Shift:

Scheduled Weekly Hours:

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.