Insurance Contract Manager Jobs in Michigan (NOW HIRING)

CONTRACT & FACILITIES MANAGER - TRAVERSE CITY Northern Lakes Community Mental Health Authority is seeking a Contract & Facilities Manager to join the team. This is a management position which involves development, implementation, coordination, and operation of a major service component for NLCMHA. This position requires substantial knowledge of public specialty behavioral health services delivered through Community Mental Health Services Programs and specialty networks, funded by Medicaid and other state and local funding sources.

This position leads the effort to develop and maintain a sufficient provider network to meet the requirements of a Community Mental Services program under state law and under contract with Pre-Paid Inpatient Health Plans (PIHPs), Medicaid Health Plans, Michigan Department of Health and Human Services (MDHHS) and other third-party payers. This position operates with considerable independence under the general supervision of the Chief Executive Officer (CEO). This position is also responsible for supervision of Contracting staff and Maintenance Workers.

This position is responsible for prioritizing both immediate and preventative maintenance for all owned and leased facilities, advising the CEO and CFO of immediate, short and long-term maintenance issues. ESSENTIAL FUNCTIONS: Responsible for the development, operation, and coordination of a major unit within NLCMHA's operations. Carry out supervisory responsibilities in accordance with NLCMHA's policies and applicable laws including daily coaching and supervision, timely performance reviews, professional development and discipline to improve performance where needed.

Will troubleshoot system problems when they occur, working closely with other supervisory and clinical staff to ensure sufficient provider network which allows as much choice as possible for consumers to live in least restrictive settings, maximizing opportunities within the counties served by NLCMHA. Leads the contract management lifecycle workflow, ensuring compliance with PIHP, MDHHS and other state and federal laws and rules related to provider contract procurement, development, and monitoring. Responsible for developing and maintaining the contracts library, where contracts are protected against editing by non-network-management staff, yet readily accessible to other department leaders.

Ongoing monitoring of NLCMHA Provider Contracts, ensuring appropriate templates are utilized to meet PIHP and MDHHS requirements. Draft, participate, and review Requests for Proposals, as needed. In collaboration with the CFO, and within accounting and procurement rules, manages all facilities purchasing and procurement processes, in order to address urgent, short and long-term facility needs.

Promote a healthy team approach to the service delivery system, manage conflicts, interpret administrative guidelines, and implement directives in a timely professional manner. Establish procedures for routinely monitoring workflow and promoting staff development. Monitor documentation of service system to ensure appropriate standards are met.

(MDHHS, PIHP, Mental Health Code, CARF, Federal Register/CFR) Serve as a resource for staff and the community at large seeking specialized services from NLCMHA. Monitor Provider Network performance and satisfaction. Provide organizational and community education and training as appropriate.

Responsible for the budget and expenditures of the entire Provider Network, including regular analyses to determine cost effectiveness and efficiencies as compared to other CMHs and specialty networks. Responsible for developing and implementing rate models for specialized residential and supported independent placements and negotiating with providers to promote successful placements in close collaboration with the clinical and finance teams. Coordinate and/or complete special projects as needed related to facility maintenance, Provider Network Management and related strategic initiatives.

Represent NLCMHA on external work groups including but not limited to: MDHHS, NMRE and county governments QUALIFICATIONS: Master of Business Administration or Master's degree in Healthcare Administration with a minimum of five (5) years' experience managing, writing and auditing contracts. Bachelor of Business acceptable with more than seven (7) years' experience in managing, writing and auditing contracts. Preferred candidate will have five (5) or more years of applicable professional experience ideally in an integrated healthcare organization with diverse managed care functions experience, e.g

network management, contract management, utilization management, claims payment, etc. Lived experience preferred if equally qualified. No licensing or certifications required.

PAY: $109,722 - $120,747 BENEFITS: Medical Insurance (4 options) Dental Insurance (2 options) Vision Insurance (2 options) Health Savings Account Healthcare and dependent care flex spending account MERS Retirement Plan (with Employer matching up to 5%) Paid Time Off (18 days in 1st year) Holidays (13 days) Employee Assistance Program Short Term Disability Long Term Disability Accidental Death & Dismemberment Insurance WORKING CONDITIONS/PHYSICAL REQUIREMENTS: This position will require irregular hours to ensure 24/7 coverage of emergency services. This position may require travel by personal vehicle if an agency vehicle is not available. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Occassionally: Lifting up to 25 lbs with or without assistance; Stretching/Reaching; Exposure to bloodborne pathogens and infectious disease; Exposure to hazardous material; Stooping (bend at waist) Frequently: Hand/finger dexterity; Talking in person; Talking on the telephone; Hearing in person; Hearing on the telephone; Vision for close work NLCMHA EEO Statement Northern Lakes CMH Authority is an equal opportunity employer and is committed to fostering a work environment that respects the dignity and worth of each individual and is free from all forms of employment discrimination, including harassment, because of race, color, sex, gender, age, religion or religious creed, national origin, ancestry, citizenship, marital status, sexual orientation, gender identity, gender expression, genetic information, physical or mental disability, military or veteran status, or any other characteristic protected by law . Northern Lakes CMH Authority will provide reasonable accommodations to individuals with disabilities or based on sincerely held religious beliefs, in accordance with applicable laws.

H iring decisions are based exclusively on merit, qualifications and business needs.