Job Details

Managed Care Manager

At Lifepoint Health, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team, you'll supportthose that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier.

The Managed Care Manager will coordinate and assist in all Commercial, Managed Medicare and Managed Medicaid, Behavioral Health, Inpatient Rehabilitation, Direct Employer and/or Workers Compensation Payor negotiations on behalf of LifePoint Health. You will complete contract reviews and compliance activities in support of the Managed Care strategies and business and provide support to the Managed Care Contractor with payer escalations related to systemic enrollment and claims related issues.

How you'll contribute:

A Managed Care Manager who excels in this role:

1. Coordinate and administer managed care contract negotiation process for designated division or as assigned.
2. Provide physician/payer contracting support by attending scheduled meetings with operations leadership with the Division/Market/Practice Management and Payers within the respective division.
3. Assist with the maintenance of permanent record of all payer contracts and fee schedules, status updates and support related service center payer contract compliance efforts.
4. Audit for accuracy contract documents, rate exhibits, and/or fee schedules for internal and external parties.
5. Prepare and distribute regular reports including, but not limited to: Division/State physician rosters, payer rosters reflecting status of new and outstanding physicians, Division/State payer matrix, summary of negotiating activities for a period, and other reports as requested.
6. Act as liaison in regards to credentialing LifePoint entities with payer plans and provide support as needed in the enrollment process to ensure timely enrollment.
7. Work with payers to resolve issues related to claims or enrollment, as escalated by Revenue Cycle, Provider Enrollment, or Division Operations.
8. Responsible for scheduling, monitoring, mediating and follow up for payor Joint Operations Committee meetings.
9. Assist in the implementation of a market-specific physician/payer contracting strategic plan.
10. Educate and mentor peers in job duties and certain onboarding activities including but not limited to systems training.
11. Administer company's guidelines for payer contracting and compliance.
12. Maintain knowledge of state and federal legislative and regulatory laws and rules regarding managed care.
13. Perform special projects as assigned by management.

Why join us:

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

What we're looking for:

Applicants should have a Bachelor degree preferred with 3 years of related experience with 1+ year(s) of experience in managed care, contract analysis or negotiations in a Business office preferred. Additional requirements include:

• Financial analysis and knowledge of Excel
• Good communication and organization skills

EEOC Statement:

Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

You must be authorized to work in the United States without employer sponsorship.