About Us
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.
Manager Payor Contracting McLaren Physician Partners
Responsible for managing Third-Party Payor contracting activities within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC), McLaren High Performance Network (MHPN) and its subsidiaries. Working with leadership, conducts complex contract modeling and analysis with an understanding of population health and value-based contracting. Professionally and effectively communicates the advantages of contracting with McLaren, provides ongoing expertise throughout the contracting process and administration of payor agreements. Key team resource to the contract management team.
ESSENTIAL FUNCTIONS AND RESPONSIBILTIES:
1. Responsible for managing contracting activities, including but not limited to review, redline, and evaluation of language, and execution of the Managed Care contracts.
2. Manages the contracting staff regarding contracting processes, workflows, and direction. Acts as a SME for all contracting activities of MPP, MHCC, MHPN and its subsidiaries, including providing ad hoc assistance and support as requested.
3. Responsible for review and resolution of billing, utilization review and administrative issues with Third Party Payors.
4. Analyzes changes in payer policies, rules and regulations impacting both facility and physician payments. Communicates and educates those impacted, as necessary. Makes recommendations to maintain regulatory compliance and internal controls as required.
5. Participates in and may lead during negotiations. Identifies any issues and coordinates contract workflow/approval through to contract execution and administration of contracts.
6. Motivates staff; defines priorities and communicates to staff organizational goals and works with them to achieve them; seeks commitment from staff, encourages innovation and team building/planning.
Required:
- Bachelor’s degree in business, health care or related field.
Five (5) years’ experience in progressively more complex provider contracting and servicing in a managed care organization, Health Plan, PHO, PO or similar organization, including two (2) years’ experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments.
Preferred:
Two (2) years in a leadership role of a professional staff or a progressively more responsible lead role leading complex projects, workflow management, etc.
Established relationships with Health Plans, other Industry Professionals.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
