Manager - Managed Care Financial Operations

We are an equal opportunity employer. All qualified applicants will receive consideration for employment. We do not discriminate for any reason.  We welcome talented individuals who believe in our mission, drive the organization forward, and recognize the positive impact they can bring to our communities.

Position Summary

The Manager, Managed Care Financial Operations manages the daily operations of the Managed Care Department, including a team and processes to design, analyze, negotiate, implement, and monitor managed care contracts.

Core Job Responsibilities

• Manage day to day interactions with health plans. Collaborate with other departments to understand and communicate issues to health plans

• Responsible for the review and monitoring of managed care contracts including compliance to contract terms, requirements from provider manuals and any other related contractual documents; performs audits based on contractual agreement and establishes corrective action plans as necessary.

• Ensures managed care contracts are in support of ACCESS care model and associated standard access to care, care coordination, case management, quality metrics

• Responsible for reviewing managed care contract information and creating materials to help disseminate new and/or updated information to a variety of ACCESS audiences.

• Provide data analysis and performance reporting in support of managed care contracts and program efforts, including financial modeling

• Manages day to day claims processing operations

• Manage direct reports, communicating expectations, providing coaching and feedback, monitoring and managing performance and providing development opportunities

• Perform other duties as assigned

Requirements/Preferences 

• Bachelor’s degree required, health or business field preferred

• Minimum of 3 years’ experience in a healthcare provider or managed care operations required

• Minimum 2 years’ experience managing staff required

• Intermediate proficiency in Microsoft Office required, especially in Word, Excel, and PowerPoint

• Experience negotiating contracts and terms preferred

• Experience in financial modeling preferred

ACCESS is a Network of Federally Qualified Health Centers treating patients on the frontlines of community-based health care. Depending on position applied/being recruited for, candidates may be required to be vaccinated against communicable diseases, and provide supporting documentation proving that they are properly vaccinated, or apply for religious and/or medical vaccination exemption as a part of the application process.