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Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday- Friday Full Time 8am-5pm hybrid (3 days onsite)

Job Location : Maitland, FL

The role you will contribute:

This position is responsible for direct and indirect negotiation, review, and completion of assigned top-tier and mid-level tier payer contracts. Duties as assigned include leading strategic managed care contracting initiatives as directed by AdventHealth leadership; managed care contract review, interpretation and analysis, negotiation, reporting, implementation for assigned mid-level and top tier payer contracts; and issue resolution across multiple entities including hospitals and/or physician practices in Florida as well as ancillary service providers owned, employed, or operated by AdventHealth. Facilitates compliance of contract terms for assigned payers by leading in strong working relationships with department staff, various hospital and provider staff, and leadership at all AdventHealth Florida markets, providers, and external managed care payers. Actively participations in outstanding customer service and serves as a primary liaison for maintained relationships that are equally respectful of all. Diligently manages the business relationship and advances AdventHealth strategic and tactical objectives with each assigned payer.

The value you will bring to the team:

NEGOTIATION (20%)

Represents AdventHealth as lead negotiator for assigned top-tier and mid-level tier managed care health plans in facilitating contract negotiations with AdventHealth business divisions to further AdventHealth strategic, tactical, and operational goals.

Assumes the role of a subject matter expert during contract negotiations by displaying proficiency and distinction related to managed care and contract negotiation topics with the intention of maintaining strategic alignment with contracted health plans.

Seeks resolution to managed care issues by collecting and interpreting contract performance information (e.g. claims volumes, quality and efficiency reports, participation gap analysis, accounts receivable data, etc.) to preserve the integrity of those contracts.

Shows full comprehension of managed care contract language for the betterment of the AdventHealth Managed Care negotiation team by writing, editing, and recommending preferred language clauses both in and out of active negotiations. Acts as a primary liaison for the AdventHealth Managed Care department by leading or contributing to meetings and projects in service of AdventHealth strategic initiatives.

Ensures the timely start of contract negotiation activities by ensuring that all necessary information relative to achieving successful negotiation is prepared and ready by performing research and coordinating with other Managed Care or AdventHealth departmental leaders and making recommendations as needed.

SYSTEMS (5%)

• Accepts responsibility for the overall contracting process by coordinating with other Managed Care teams and outside business units as applicable to identify contract implementation elements and opportunities.
• Exhibits research proficiency using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively lead in contract negotiation and issue resolution. Coordinates with multiple internal teams (e.g. Contract Management, Finance, etc.) and external teams (e.g. PFS, Pre-Access, etc.) to ensure that contracting information is correct and up to date in all applicable Managed Care documentation and resources.

REGIONAL REPRESENTATION (15%)

• Assumes responsibility as a managed care liaison to assigned AdventHealth providers by leading or contributing as needed to contracting strategy development and implementation for the purposes of advancing the initiatives of those providers within the overall scope of AdventHealth managed care strategy
• Assumes responsibility as a managed care liaison to assigned AdventHealth providers by leading or contributing as needed in identification and resolution of issues related to contract performance to maintain effective relationships between those providers and contracted health plans.
• Promotes strong relationships between assigned health plans and AdventHealth providers as well as AdventHealth as an entity by effectively managing relationships between collaborative business units on either side to facilitate long term partnerships between AdventHealth and contracted health plans.
• Effectively makes strategic recommendations to AdventHealth provider business units and senior leadership to advance AdventHealth initiatives by evaluating new managed care opportunities related to identified health plan strategies (e.g. strategic business decisions, publications, behavioral trends, new product lines, benefit design, etc.) to appropriately respond to perceived healthcare market changes.

DEADLINES AND TIMELINESS (10%)

• Manages tasks to completion by developing timetables, milestones, and deadlines with the help of senior leadership to ensure the timely adherence to AdventHealth strategic goals.
• Consistently achieves high performance by displaying a self-directed and highly motivated attitude contributing to a satisfactory work pace with minimal direct supervision.
• Ensures that group-oriented tasks are completed timely by participating as an engaged member in committees and work groups, leading such activities as necessary, to comply with the directives and expectations as assigned to the group.
• Assists coworkers within the Managed Care department by providing support and expertise relative to assigned negotiator job duties to help the timely completion of projects assigned to others.
• Maintains excellence in responding to changing priorities by effectively adapting to new expectations and situations to contribute to changes in strategic initiatives.

COMMUNICATION (15%)

• Effectively communicates with coworkers, leadership, AdventHealth as well as outside business unit leaders, and health plans through verbal and written messages establishing a clear, professional, and courteous position on behalf of AdventHealth.
• Contributes to meaningful discussion by leading or participating as necessary in meetings, including planning, scheduling, and coordinating such meetings with health plan representatives as well as AdventHealth provider staff and leadership, to maintain an appropriate and effective of communication with AdventHealth Managed Care.
• Accepts full responsibility for updates related to ongoing contract negotiations by ensuring the timely communication of updates (e.g. issues, requests for information, changes to negotiation parameters, etc.) to Managed Care leadership, AdventHealth provider staff and leadership, and health plan representatives as applicable, so that appropriate adjustments can be made to contract strategy and action. Collaborates with the Managed Care contract administration team to provide timely notification and follow-up as appropriate to AdventHealth provider departments (e.g. Revenue Management, Medical Management, PFS, Pre-Access, etc.) and senior leadership for the purposes of advising as to parameters of contract completion, implementation, and performance.
• Facilitates communication between leadership across AdventHealth providers as applicable by sharing contracting strategy and initiatives for the purpose of streamlining operational performance throughout AdventHealth.
• Exercises care and respect with regards to protected health information (PHI) as well as trade secrets and proprietary information by ensuring confidential and secure communication as appropriate to ensure the protection and safety of sensitive information.

SUPPORT (5%)

• Supports the overall mission of AdventHealth through mindful and focused work in alignment with the role of the Managed Care department.
• Facilitates contract negotiations and other managed care projects in all payer tiers by coordinating other negotiation team members to fully execute Managed Care strategic initiatives.
• Demonstrates an awareness of unique situations by advising, recommending, and performing special projects as applicable to improve the role and function of the Managed Care department.
• Effectively supports managed care teams and AdventHealth provider departments to identify, quantify, and resolve financial and operational issues related to accounts receivable, utilization management, quality assurance, billing, pre-access, care management, and other related issues through application of managed care expertise, ongoing regular job duties, and special projects.
• Contributes to the financial goals and viability of the organization and its business units by contracting appropriate rates and terms in accordance with AdventHealth directives and market standards for the overall financial success of AdventHealth providers.

PERFORMANCE STANDARDS (10%)

• Ensures that job duties and tasks are performed appropriately by adhering to applicable internal policies set forth by AdventHealth and its associated providers to further the strategic initiatives of the organization.
• Ensures that job duties and tasks are performed appropriately by abiding by all applicable rules, regulations, and laws prescribed by any authoritative governing body (e.g. State of Florida, AHCA, CMS, etc.).
• Refines ongoing managed care processes by developing information and documents such as contract language and negotiation strategies for the purpose of enhancing performance standards in the Managed Care department.

DEVELOPMENT, EDUCATION AND TRAINING (10%)

• Encourages the professional growth and development of others by leading or participating in managed care training and education sessions to continually improve the effectiveness of the Managed Care department.
• Displays a willingness to grow and develop contracting and other healthcare skills required to perform job duties by attending training and education opportunities as they are presented to stay ahead of changes in the industry and further the strategic initiatives of the Managed Care department and AdventHealth.
• Educates AdventHealth leadership, departmental management, and AdventHealth multi-state peers by developing educational materials and activities to streamline contract negotiation strategy and improve overall managed care performance.
• Actively participates in industry advocacy groups (e.g. Florida Hospital Association) by contributing to requests for information or participation as applicable to support legislation and policy for healthcare providers as it relates to managed care.

The expertise and experiences you'll need to succeed:

• Bachelors degree in healthcare or related field or equivalent work experience
• Minimum of 5 years training or experience in contract negotiations and/or contract administration and implementation
• Direct experience with managed care contract negotiation, administration, or implementation.
• Understands key elements of a contract as well as negotiation practices and processes
• Typing: 35 wpm

Preferred Qualifications:

Masters degree

Understands the basic functions of a large integrated healthcare system.

Understands key elements of a contract as well as negotiation practices and processes

Can develop, implement, and execute research plans

Strong organizational skills

Self-motivated with the flexibility to multitask and restructure priorities in a fast-paced environment

Professional attitude and conduct

Word processing, spreadsheet, and database proficiency

Proficiency with email, computer calendar, and web-based meetings and resources

Excellent communication skills, both verbal and written

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25026977

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.