Managed Care Plan Specialist

Discovering a professional or business career in health care where the opportunities, challenges and rewards match your desire to make a difference — This is Real! Seek joy with us here at JPS Health Network and own it like nowhere else.

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Position

Req #: 10112
Category: BUSINESS/PROFESSIONAL
Division: Finance
Employment Type: Full Time
Shift: Day
Hours:
Compensation Type: Salaried
Facility: JPOC 1350
Location: 1350 S. Main Street, Fort Worth, TX

Description

Description: The Managed Care Plan Specialist negotiates and administers healthcare costs, contracts, and agreements with a variety of healthcare vendors for the Network and Provider groups. The Managed Care Plan Specialist makes recommendations for rates, performs grant contracting and reviews contracts. The Managed Care Plan Specialist possesses a mastery of negotiation, benefit, and costs analysis skills and exercises initiative and judgment when making decisions within the scope of assigned authority. Typical Duties:

  1. Negotiates healthcare contracts to establish contract terms and rates for the Network’s managed care needs.
  2. Serves as the liaison between the healthcare companies/vendors and the Network.
  3. Provides estimates of healthcare costs in order to project levels of spending and assists in preparing annual budgets relative to healthcare costs.
  4. Prepares timely and accurate information for Registration, Inpatient Case Management, Patient Financial Accounts, Legal (including the District Attorney’s office), Patients, and Citizens relative to managed care.
  5. Develops new and maintains existing relationships with major and small Insurers, Provider Networks, and Federal and State entities. Contracts with vendors on behalf of the Network.
  6. Analyzes, reviews, and evaluates Payors reimbursement adherence to contract terms and/or agreements. Enforces the contract terms and/or agreements when lapses occur.
  7. Manages the Development of the Health System relative to revenue growth and the reduction of non-reimbursed services.
  8. Identifies and make recommendations on the need for contracting or reimbursement policies or innovations with Health Network
  9. Promotes departmental and organizational activities for providing courteous customer service to patients, families, visitors and external customers.
  10. Performs other related job duties as assigned.

Qualifications

Qualifications:

    Required Education and Experience:

  • Bachelor Degree in Business Administration or Healthcare Administration from an accredited college or university.
  • 5 plus years HMO management and contracting experience with hospital and Primary Care Plans.
  • Preferred Education and Experience:

  • Experience with multiple managed care product lines.
  • Experience working in Public Sector.

About

JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas. Licensed for 578 beds, the network includes an acute care hospital and more than 40 community-based clinics, including 19 school-based clinics. John Peter Smith Hospital is home to Tarrant County’s first and only Level 1 Trauma Center, its only psychiatric emergency services site and has the largest hospital-based family medicine residency program in the nation. Our network employs more than 6,500 people.

Acclaim is our multispecialty medical practice group. Acclaim has over 300 providers serving the JPS Health Network in specialties ranging from primary care to general surgery and trauma. The Acclaim group has been formed around a common set of incentives and expectations supporting the operational, financial and clinical performance
outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

For more information, visit www.jpshealthnet.org .
To view all job vacancies, visit www.jobs.jpshealthnet.org/ or www.teamacclaim.org .
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