Job Description

Management/ Professional


Managed Care - System

Req Number:

Job Details:


This position will be responsible for a variety of functions under the Managed Care Department including developing financial models and proposal valuations to support managed care contracting negotiations. In addition to strong hospital and physician FFS reimbursement modeling skills, a particular emphasis will be analyzing value based care arrangements, including total medical expense budget based models, percent of premium arrangements and quality driven models. Other key responsibilities include managed care budget development, fee schedule valuation and modeling of payer reimbursement changes that may impact managed care contract performance.


* Provide financial analytic support for managed care contract negotiations with Commercial, Medicare, and Medicaid payers that includes:
* Develop detailed financial models to value risk based managed care contracts, including budget based, total medical expense network trend based, and percent of premium models
* Develop detailed FFS rate models to value various hospital and physician FFS rate and fee schedule updates/changes, including health plan reimbursement policy changes that may impact overall provider system reimbursement. As well as build FFS rate conversion models that ensure revenue neutrality or other targeted rate objectives.
* Assist managed care contracting team in negotiating contracts with payers
* Provide analytic support for managed care contract strategy development and implementation
* Perform managed care contract rate review and other ad hoc projects as requested under the supervision the Senior Vice President of Managed Care
* Provide oversight, mentoring and support for lower level analytic resources
* Maintain constructive, professional relationships with internal and external stakeholders


* Solid knowledge of hospital and professional FFS reimbursement methodologies and proficient at building models to value FFS reimbursement terms.

3+ years experience in a health care analytic environment: Health Plan or Accountable Care Organization (ACO) experience recommended
* Experience evaluating managed care risk models necessary, TME network trend based and percent of premium modeling experience recommended
* Advanced Microsoft Excel financial modeling skills necessary and other database analytic experience such as SAS, SQL, or Microsoft Access a plus; querying and manipulation of large data sets
* Knowledge and understanding of the healthcare market as context for contract interpretation and analytic responsibilities a plus
* Accuracy and attention to detail is critical
* Strong interpersonal skills and ability to interact positively with a wide range of constituents
* Strong quantitative and analytical skills
* Ability to understand complex concepts
* Ability to work independently and take initiative to add value to a team located in various states
* Ability to manage multiple projects and deadlines
* Ability to work in a fast paced, evolving organization


Education: Bachelor's degree required in business, health care administration, finance, or related fields, Master's degree strongly preferred

Experience: 3-5 years work experience in a health care financial analytic environment

MS Office proficiency and advanced abilities in Microsoft Excel required

Understanding of the health care delivery system.

Application Instructions

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