BJC Healthcare Director of Managed Care in Saint Louis, Missouri
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BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions.BJC serves patients and their families in urban, suburban and rural communities through its13 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
Includes Provider Relations staff who develop and maintain processes for improvement for the communications between the health plans and BJC entities and resolution of issues in a timely manner. Managed Care contracting resolves plan issues through contract language, and conducts an on-going process for monitoring BJC entity communications regarding managed care contracts and the impact on BJC entities. Represents BJC hospitals to managed care companies for contracting and provider relations. Works with Managed Care Finance to evaluate the financial impact of rate proposals, assuring the financial advantage of each contract. Provides plan administration for second level appeals and serve as the primary technical liaison with the TPA that administers BJC's self-insured health plan.
Provides leadership on the issue of quality/pay for performance and transparency. Provides interface to corporate clinical quality group, as well as Managed Care contract negotiation team. Establish national contacts and visibility for BJC in context of pay for performance.
Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
Develops and adheres to departmental staffing, revenue and/or expense budgets. Responds to changes in the business which may affect the ability to achieve the budget goals.
Builds and maintains national, state, and local surveillance databases of appropriate federal government, payor, and employer pay for performance, transparency, and clinical quality initiatives, including specific measures being utilized.
Develops internal relationships and serves as managed care liaison with BJC hospitals marketing executives, chief medical officers, and other appropriate leadership. Establishes national technical and strategic contacts for BJC in the areas of quality measurement, pay for performance and transparency.
Interfaces with the corporate clinical quality group, providing financial and marketing perspective and guidance. Provides leadership and ongoing support to relevant clinical quality committees.
Ensures pay for performance provisions are advantageously incorporated into BJCs payor contracts.
Establishes and maintains contacts with employer and broker communities. Plans and leads broker outreach program and broker roundtable events.
- 5-10 years
- 2-5 years
- Business/relatedBenefits Statement
Note: not all benefits apply to all openings
- Comprehensive medical, dental, life insurance, and disability plan options- Pension Plan/403(b) Plan- 401(k) plan with company match- Tuition Assistance- Health Care and Dependent Care Reimbursement Accounts-On-Site Fitness Center (depending on location)-Paid Time Off Program for vacation, holiday and sick time
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.
Equal Opportunity Employer