Campus Pride Jobs

Regional Manager - Managed Care Facility East Liverpool City Hospital Location US-OH-East Liverpool ID 2024-186817 Category Manager Position Type Full Time Shift Days Job Type Exempt Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! East Liverpool City Hospital, a member of the Prime Healthcare Foundation, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. East Liverpool City Hospital is an award-winning community hospital proudly serving residents of the tristate region since 1905. With 152 licensed beds and more than 500 employees, the hospital averages 31,000 Emergency Department visits annually. East Liverpool's medical staff is comprised of more than 160 physicians with an additional 21 resident physicians completing their training in Family Medicine and Internal Medicine. The hospital provides 24/7 emergency services, general surgery, medical stabilization for substance abuse, behavioral health for adults over the age of 55, and remains the ONLY cardiac rehabilitation program in Columbiana County. For more information, visit www.elch.org. Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOCKnowYourRightsscreenreader10_20.pdf Responsibilities 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,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. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Bachelor of Business/ Health/ Management field or relevant bachelor's degree, preferred 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. Connect With Us! Not ready to apply? Connect with us for general consideration. We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, sexual orientation, gender, gender identity, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources: hr-prime@primehealthcare.com