Operations Manager, Managed Care

Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated.

Position Summary: The Operations Manager, Managed Care is responsible for the day-to-day operations of the PHO’s governmental and managed care contracts to help position the network physicians strongly with new programs, networks and relationships. They will be deeply involved in the analysis, initiation, operations, development, and implementation of key governmental and managed care programs which will continue to enhance Silver Cross’ position in the marketplace and have responsibility for the overall management of the Silver Cross Health Connection. Works directly with Essential Health Partners (EHP).

The Position reports to the Administrative Director of Value Based Care

Essential Duties and Responsibilities:

•  Run day to day operations that will help enhance and expand revenues for the Hospital through contracts with commercial and governmental payors.
• Implement and manage utilization management, quality and risk coding program.
• Identify ways to offer gain sharing opportunities to network physicians and steps to implement programs.
• Proactively communicate and create strong relationships with physicians, colleagues, and payor contacts.
• Position Silver Cross Hospital and Silver Cross PHO as a top Performer and gain access to “first to market opportunities.
• Implement strategy for network development inclusive of but not limited to provider relations, credentialing, and network management of the PHO and EHP.
• Evaluate opportunities and make recommendations to physicians and senior management
• Integrate pricing, contracting and program development strategies to maximize volume and profitability.
• Align and maintain portfolio of contacts to assure consistency and sustainability.
• Review contracts annually, for both the Hospital and PHO, and execute appropriate management strategies to ensure profitability.
• Employee decision support tools to model and identify opportunities to negotiate improved pricing.
• Provide overall management and guidance for the PHO’s vendor partnerships.
• Enhance and develop clinical integration and financial integration programs for network physicians and manage the PHO’s regulatory compliance of the programs.

Required Qualifications: 

Education and Training:

• 10 years’ experience in healthcare at commercial payors, hospitals or consulting firms
• Bachelors degree in Business Administration or related field required.
• Relation with local commercial payor healthcare executives
• Significant experience contracting and population health programs
• Experience with Medicare Advantage
• Direct Contracting with Large employers preferred
• Working with physician organizations.

Work Shift Details:

Department:

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.   

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

·       Medical, Dental and Vision plans

·       Life Insurance

·       Flexible Spending Account

·       Other voluntary benefit plans

·       PTO and Sick time

·       401(k) plan with a match

·       Wellness program

·       Tuition Reimbursement

Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match.  However,registry employees are ineligible for Health and Welfare benefits.

The expected pay for this position is listed below:

The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.