Regional Manager - Managed Care - Southern Regional Medical Center

Committed to Delivering Compassionate, Quality Care to Patients

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Southern Regional Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Our dedicated team of professionals are committed to our core values of quality, compassion, and community.  As a member of Prime Healthcare, Southern Regional Medical Center is actively seeking a per-diem day L&D nurse to join its award-winning team!  We offer:

• competitive compensation
• generous benefits plan: medical, dental, vision, 401K
• substantial PTO
• continuing educational opportunities
• …and much more!

Southern Regional Medical Center is a non-profit, 331-bed full-service hospital serving the residents of Clayton County and southern crescent metro Atlanta communities. The hospital offers a complete line of services including Senior Care and Senior Behavioral Health Services; Emergency Services; Heart and Vascular; Advanced Imaging; Laboratory; Neuroscience Services; Rehabilitation; Sleep Diagnostic Center; Surgery/Robotic Surgery; Wound Care; and Women’s Health Services, including a Level III NICU. The hospital is certified accredited as a Chest Pain Center and Primary Stroke Center. Learn more at southernregional.org.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

*** This position is remote ***

Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed care agreements in place at all hospital facilities and employed physicians. The Regional Manager effectively interacts with Corporate Executive Management, Hospitals, and Business Office Management and Medicare, Medicaid, exchange and commercial insurance payers. The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; assist in the measurement of payer compliance with contract terms; participate in JOCs; and assist hospital and business office management in resolution of issues related to managed care agreements. This position offers a competitive compensation and great benefits. 

In this role you will be responsible for Negotiation, Contract Managment, Healthcare Agreements, Payer Contracts, Reimbursement Rates and Health Insurance. Involving Medicare/Medicaid, Value-Based Care, Healthcare Laws and Fee Schedules. 

EDUCATION, EXPERIENCE, TRAINING
 
1. Bachelor of Business/ Health/ Management field or relevant bachelor’s degree
2. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management
3. 5 years of contract negotiation/managed care experience in a hospital or hospital system setting, required
4. Previous behavior health contracting, joint operating committee and C-suite collaboration experience is a plus
5. Business office and claims knowledge and/or experience, preferred
6. Must obtain Sexual Harassment Certification within 6 months, and then maintain biennially.

We are looking for someone who has #contractnegotiations in a #managedcare environment. Experience working in #healthcare working with #healthinsurance companies is a must.  

#LI-MM1