Manager – Managed Care Financial Operations

Position Summary (Rephrased)
The Manager of Managed Care Financial Operations oversees the daily functions of the Managed Care Department. This role leads a team responsible for designing, analyzing, negotiating, executing, and monitoring managed care contracts.

Core Responsibilities

• Serve as the primary point of contact with health plans, working closely with internal departments to resolve and communicate issues.

• Review and monitor managed care contracts to ensure compliance with terms, provider manuals, and related documents; conduct audits and implement corrective action plans when needed.

• Ensure contracts support ACCESS’ care delivery model, including access to care, coordination, case management, and quality metrics.

• Create and distribute materials that summarize and explain updates to managed care contract terms to various ACCESS stakeholders.

• Provide performance reporting and data analysis in support of contracts and program initiatives, including financial modeling.

• Oversee daily operations of claims processing.

• Lead and develop a team by setting expectations, offering coaching and feedback, evaluating performance, and supporting professional growth.

• Perform additional duties as assigned.

Qualifications and Preferences

• Bachelor’s degree required; healthcare or business focus preferred.

• At least 3 years of experience in managed care operations or with a healthcare provider.

• Minimum of 2 years’ experience in staff supervision.

• Proficiency in Microsoft Office, especially Excel, Word, and PowerPoint.

• Contract negotiation experience is preferred.

• Financial modeling experience is a plus.

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