Overnight Utilization Management Jobs (NOW HIRING)

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Job SummaryBASIC FUNCTION
HCSC is looking for a dynamic individual to join its Provider Network management team! This position is responsible managing daily activities and implementation of strategies for provider recruitment and contracting of physicians, physician groups and facilities including large or complex groups/facilities (large independent hospital systems, integrated & non-integrated systems, value based contracting, etc.). Will develop and negotiate contracts; develop and maintain relationships with providers and ensure strategic coverage for assigned territory. Role is responsible for education of providers and for ongoing provider service; will be responsible for the management, mentoring and training of a team responsible for provider contracting and provider support resources and provide subject matter expertise to improve efficiencies and results. Must have the ability and willingness to travel within assigned areas of responsibility, including overnight stays. Neither relocation nor sponsorship (either now or in the future) will be extended. In-office visibility is required three days per week, working from home the other two days.
NOTE: this is NOT an Information Technology or computer systems aligned role.
#LI-TP1
#LI-hybrid

JOB REQUIREMENTS

• Bachelor's Degree and five (5) years of provider contracting experience OR 9 years' of direct, managed care experience including five (5) years of provider contracting experience.
• Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
• Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues.
• Solid negotiation skills.
• Strong relationship building skills.
• Extensive knowledge of the healthcare marketplace.
• Able to meet deadlines and work well under pressure.
• Excellent verbal and written communication skills to interact with all levels of corporate personnel and providers.
• PC proficiency to include Microsoft Office (Word, Excel, Outlook, PowerPoint).
• Keen analytical skills.
• Project management skills to lead or participate in projects or initiatives.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

PREFERRED JOB REQUIREMENTS

• PMP Certification.
• HCISPP (Healthcare Information Security and Privacy Practitioner).
• Strong knowledge of hospital, professional physicians and ancillary.
• Salesforce acumen.

~ KEY FUNCTIONS ~

1. Ensure assigned staff performs according to established standards. Assign duties, monitor results, control budget, and appraise performance and direct staff as appropriate.
2. Management duties include but are not limited to: hiring, performance management, pay administration, change management, talent management, and maintain knowledge of corporate, divisional and Human Resources policies, programs and systems.
3. Work with internal departments to ensure appropriate implementation of executed agreements.
4. Analyze financial reports to determine financial impact of negotiations.
5. Develop and negotiate agreements with providers and facilities (including large independent hospital systems, integrated & non-integrated systems, value based contracting, etc.) within assigned territory of responsibility.
6. Responsible for maintaining a professional relationship with key provider groups. Ensure effective liaison and rapport is developed and maintained through meetings, correspondence and telephone calls.
7. Ensure strategic objectives are being met with regard to physicians, physician groups and facilities needed for assigned territory(s). Ensure appropriate provider services including working across departments to resolve issues. Meet/exceed service goals.
8. Oversee the servicing of facilities, large groups, and/or capitated entities to include assisting with eligibility and capitation issues, contracting issues, and bonus arrangements. Serves as a liaison between internal departments and the capitated entity.
9. Work with delegated entities to ensure that providers are loaded correctly.
10. Work closely with the delegation oversight department regarding the delegated entity reporting requirements to include claims delegation, utilization management delegation and credentialing delegation.
11. Respond to provider inquiries in an effective and timely manner and assist in claims resolution and payment problems.
12. Must work closely with the Pricing, Full Service Units, Utilization Management, Medical, Delegation Oversight, Core Credentialing, Provider Automation and other divisions within the company.
13. Provide leadership regarding negotiation of rates for traditional and managed care business. Conduct and assist in the negotiation process and assure that providers are kept informed of pertinent changes in policies and procedures.
14. Coordinate appropriate education/in-servicing is provided for providers. Education may pertain to managed care and areas where pertinent rulings/regulations could affect business.
15. Explain corporate policies and procedures to contracted providers; counsel with provider's staff to ensure their familiarity with Blue Cross procedures.
16. Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls.
17. Coordinate and direct the activities of the provider network staff.
18. Serve as a mentor/teacher regarding the activities of staff.
19. Monitor various reports, team activities and results regarding team performance objectives.
20. Ensure the establishment and maintenance of an appropriate team focus.
21. Serve on local and corporate committees and task forces that require input from Network Management Department. Participate in trade association meetings, as required.
22. Transform fee for service contracts to fee for value.
23. Develop reports and analyze performance outcomes.
24. Ensure all expenditures comply with corporate and divisional expense guidelines.
25. Other duties as assigned.
26. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
27. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
28. Maintain complete confidentiality of company business.
29. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$92,700.00 - $167,500.00

Exact compensation may vary based on skills, experience, and location.