Manager, Managed Care Administration & Operations

Location: Burlington, MA
Job ID: 151997-1A
Date Posted: Dec 19, 2018

Job Description

Welcome To

Lahey Health Shared Services is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job

Position Summary:

Under the general direction of the Vice President of Contracting, identifies issues of concern or importance to Lahey Health and LCPN (“Lahey”) and advocates for Lahey's interests with the payors.  Serves as key contact for contract implementation, policy changes by the payors, communicates with appropriate Lahey management, and negotiates regarding these updates on behalf of Lahey.  Strengthens and maintains  relationships with key payors, promotes Lahey's interests and educates payors about Lahey.  Facilitates effective working relationships between key individuals at major payors and appropriate management staff at Lahey.  Identifies trends in reporting and measurement of clinical measures for each insurer and coordinates Lahey approach to these measures. Coordinates internal efforts to identify issues and facilitate communication regarding payor issues among Lahey operational managers.

 

Essential Duties & Responsibilities including but not limited to:

  • Identify operational issues with key payors and negotiate successful resolutions
  • Serve as key liaision to major payors and maintain close working relationship with key  payor operational staff and negotiate resolutions for issues  related to policy updates, substantial changes in benefits or, enrollment, or operational isues 
  • Maintains Health Plan Participation by Risk Unit grid and updates Lahey.org and MassNet health plan information.
  • Educate key payors regarding Lahey and promote Lahey individual strengths and capabilities at payors
  • Establish communication channels with Lahey management to assure bidirectional flow of information regarding payor issues relevant to their work and facilitate communication bertween Lahey operational managers and appropriate staff at payors to optimize operations.
  • Identify contractual incentive measures for which each insurer will be measuring Lahey Clinic providers, and coordinate Lahey response so as to identify improvement opportunities and optimize results for appropriate measures, including supervision of interns or other trainees in data analysis and collection.
  • Supervise Information and Reporting Specialist
  • Manage payor initiatives such as tiering methods, product updates, policy and procedure changes, payor training.
  • Oversees department administrative assistant in her/his work on patient/member calls when department administrative assistant is absent. Supervises her/his work on health plan participation and with patient calls. Provides guidance to administrative assistant as needed.
  • Coordinates on behalf of Contracting department, internal projects related to payors and contracts.
  • Liaison with MHQP for Lahey Clinic. Oversees annual MHQP provider data base updates for Lahey.
  • Assists LCPN with clinical quality and contract incentive metrics as needed.
  • Negotiates special contracts as needed.

 

Minimum Qualifications:

Education:   Bachelor’s degree in related field, Master’s degree in healthcare preferred

Experience:  5-10 years at the management level preferably with key payors in MA, with demonstrated successful problem resolution and effective project management. Experience with managed care; experience with complex provider organizations.   Customer communication experience.

Skills, Knowledge & Abilities:  Outstanding verbal and excellent written communication skills; outstanding ability to work with individuals at multiple levels of organizations to identify problems and bring them to satisfactory resolution; excellent ability to anticipate impacts of proposed changes and to communicate them to those who need to know.  Proven ability to work independently and in a collaborative team environment.  Excellent ability to prioritize multiple projects; ability to consistently maintain appropriate professional demeanor under sometimes stressful circumstances.  Ability to analyze mathematical data.

 

About Us

The Lahey Model of Care—right care, right time, right place—is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.