Additional Information About the Role

System Director, Managed Care Contracting

Overseeing for the system the managed care contracting and managed care systems for both the West and East Regions.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

The BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value-based care and payment programs, payor and provider relations, and direct to employer solutions.

Preferred Qualifications

Role Purpose

Responsible for system-wide managed care Contracting documentation, negotiation calendar and work plans, supporting SVP/VP in negotiations with largest payors, and direct negotiations with medium and smaller payors regarding contract language and rates as directed; research and support of managed care contracting strategy; and coordination with other managed care functions (Reimbursement Analytics, VBC) and other areas within the system (Corp or hospital-specific Finance); and East Region Epic system contract/rate loads, Q&A, reporting and analytics.

Responsibilities

Manages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.

Develop and execute Managed Care strategies that preserve and enhance BJC's financial viability, promote growth and create broad access to BJC Affiliates. Collaborate with system leaders to prioritize and execute strategies. Provide financial analyses to support strategic initiatives and leverage resources.

Responsible for overseeing the strategic planning, successful negotiation, execution and monitoring of performance for all BJC managed care contracts, including pricing strategies, methodologies, alternate payment models and favorable contract language protections. Lead all aspects of contract negotiations with the health plans from the start through successful completion of the Agreement. Review and develop contract language that protects revenue and improves administrative functions. Direct financial analyses to support contract negotiations including developing the financial strategy and targets, setting the time line for the negotiations, overseeing the development of the financial model and rate proposals, and communicating to leadership. Collaborate with the Center for Clinical Excellence (CCE), Hospitals Service Organizations (HSOs) and BJC Medical Group leaders around pay for performance/shared savings arrangements, including developing metrics, targets and performance reports. Collaborate with the HSO's finance departments to identify opportunities for improvement around contract rates and methodologies to meet their operating margin needs. Ensure that contracts are loaded timely and accurately in the contract modeling system to ensure correct payment of services.

Provide support for BJC wide initiatives around value based contract models, including executing contracts, providing data analytic and financial support and participating on system focused committees. Oversee the development of report packages that support for various value based arrangements. Responsible for the accurate and timely reconciliation process for CMS bundles, ensuring that the correct gain share payouts are distributed to the appropriate individuals. Provide analytical and reporting support for the pay for performance/shared savings programs in order to monitor performance and improve outcomes.

Continuously monitor the competitive environment to understand managed care trends impacting current and future healthcare business and reimbursement models in order to identify opportunities around payer activities, payment policies and product development. Establish network of relationships with other providers, payers, and national organizations in order to create a sharing and learning environment.

Minimum Requirements

Education

Bachelor's Degree

- Accounting/Finance/related

Experience

2-5 years

Supervisor Experience

2-5 years

Preferred Requirements

Education

Master's Degree

Licenses & Certifications

CPA

Benefits and Legal Statement

BJC Total Rewards

At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
Disability insurance* paid for by BJC
Pension Plan*/403(b) Plan funded by BJC
401(k) plan with BJC match
Tuition Assistance available on first day
BJC Institute for Learning and Development
Health Care and Dependent Care Flexible Spending Accounts
Paid Time Off benefit combines vacation, sick days, holidays and personal time
Adoption assistance

To learn more, go to www.bjctotalrewards.com/Benefits

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer