Manager-Managed Care, Roper St. Francis Healthcare

Thank you for considering a career at Roper St. Francis Healthcare!

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

Location: Roper St. Francis Office Park, Ladson, SC

Shift: 8:00am-5:00pm

Job Summary:

The Manager of Managed Care is responsible for implementing and overseeing the daily operations of managed care programs and initiatives and the provider credentialing and enrollment program. This role ensures effective management of relationships with payors, healthcare providers, and other stakeholders to improve patient care, control costs, and enhance the efficiency of care delivery.

Key Responsibilities:

• Contract Management:

• Oversee the daily operations of managed care arrangements, including value-based arrangements, ensuring compliance with contractual agreements and regulatory requirements.

• Monitor and evaluate the performance of managed care initiatives.

• Support (and lead certain) managed care contract negotiations and contract related issues and disputes.

• Provider Credentialing/Enrollment:

• Manage the Provider Credentialing/Enrollment process.

• Provide guidance to RSFH on the structure of enrollment set up to comply with payor policies.

• Develop and maintain delegated credentialing program.

• Relationship Management:

• Act as a liaison between RSFH and payors, health plans, and other managed care entities.

• Resolve issues related to claims, authorizations, and reimbursements.

• Data Analysis & Reporting:

• Analyze data related to patient care, utilization, and cost to identify trends and opportunities for revenue improvement.

• Prepare and present reports on managed care performance, including financial performance and quality metrics.

• Team Leadership:

• Supervise and mentor payor credentialing and enrollment staff, providing guidance, support, and professional development opportunities.

• Coordinate with other departments to ensure seamless integration of managed care processes with overall organizational goals.

• Compliance & Quality Assurance:

• Ensure adherence to federal, state, and local regulations, as well as accreditation standards.

• Implement and monitor quality improvement initiatives to enhance care delivery and patient outcomes.

• Strategic Planning:

• Contribute to the development of organizational strategies related to managed care and population health management.

• Identify opportunities for new managed care partnerships and programs that align with organizational goals.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification: N/A

Education:

• Bachelor’s degree in accounting, finance, or related field.

• Master’s degree in business or healthcare administration preferred.

Work Experience:

• Five years of provider experience as a contract negotiator.

• Payor or healthcare system experience.

Training : N/A

Language : N/A

Patient Population:

The following must be included in all position descriptions that involve direct or indirect patient care. This is a Joint Commission requirement. Also, select the age of the patient population served:

• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.

• Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.​

Working Conditions:

• Periods of high stress and fluctuating workloads may occur.

• Long-distance or air travel as needed- not to exceed 10% travel.

• General office environment.

• May be exposed to high noise levels and bright lights.

• May be exposed to physical altercations and verbal abuse.

• May be exposed to limited hazardous substances or body fluids.

• May be required to use physical restraints.

• May be exposed to human blood and other potentially infectious materials.

• May be exposed to adverse weather conditions; cold, hot, dust, wind, etc.

• May have periods of constant interruptions.

• Required to car travel to off-site locations, occasionally in adverse weather conditions.

• Prolonged periods of working alone.

Physical Requirements:

• Frequent sitting.

• Frequently requires long periods of working at a computer.

• Intermittent walking, standing, stooping, bending.

• May require lifting or moving items up to 25 lbs.

• Frequent use of finger/hand dexterity.

• Constant talking or hearing.

• Corrected hearing and vision to normal range.

• No exposure to blood, body fluids or tissue.

• Possible exposure to infectious materials, communicable diseases and/or other conditions common to a healthcare environment. Normal office environment.

• Requires work under stressful conditions, deadlines, and/or irregular hours.

• Ability to read and comprehend.

Skills:

• Ability to manage and operate department within budgetary guidelines.

• Skilled in leading, managing, and coordinating work of payor credentialing staff.

• Ability to identify process improvements, develop new process/procedures to improve quality, efficiency, customer service and carry through to completion.

• Ability to research managed care and payor credentialing issues to solve problems and form appropriate conclusions.

• Strong written and verbal communications skills and ability to prepare, analyze and interpret information. Ability to exercise good judgment in areas of high complexity when the situation warrants.

• Keep up with relevant industry and managed care and credentialing developments to provide guidance and technical support to staff.

Roper St. Francis Healthcare is an equal opportunity employer.

Many of our opportunities reward* your hard work with:

• Comprehensive, affordable medical, dental and vision plans

• Prescription drug coverage

• Flexible spending accounts

• Life insurance w/AD&D

• Employer contributions to retirement savings plan when eligible

• Paid time off

• Educational Assistance

• And much more

*Benefits offerings vary according to employment status.

Department:

SS Managed Care - Contracting - Roper St Francis Healthcare

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at .