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Supervisor HMO

Accountable Care Organization

 

Address   Franciscan Health
    5454 Hohman Avenue
    Hammond, IN 46320

Hours  Days

Calendar  Full-Time

Education Master's Preferred

WHAT WE NEED

Detail-oriented Supervisor

WHO WE ARE LOOKING FOR

Exceptional quality health care doesn’t happen by luck; it happens because there is a team of professionals working together – each doing their own job to the highest standards and working together for a common goal. Our HMO Supervisor is an important part of this team by monitoring the profitability of managed care contracts, conducting needs analysis, and so much more.

Do you have excellent follow-through skills? Would you like to work in a place that values your skills and believes that serving with faith is the best possible way to serve? We have a team of people waiting for you.

WHAT YOU WILL DO
  • Analyze capitation distributions among providers, make recommendations of reallocation of capitation and oversee stop-loss insurance activities to monitor proper reimbursement to the organization.
  • Communicate, resolves issue, and coordinate dispute resolution activities to promote effective working relationships with physicians, patients, payers, and managed care consultants.
  • Develop, approve and implement departmental policies, procedures and programs, and evaluate the financial impact to ensure departmental effectiveness and financial success.
  • Maintain/develop an adequate provider network.
  • Monitor managed care activities by coordinating the production of denial and other operational managed care payer difficulties reports.
  • Monitor program financial and utilization trends.
  • Negotiate, monitor performance, coordinate and maintain managed care contracts to identify and implement new managed care business opportunities.
  • Participate in people management activities for direct team members such as conducting performance evaluations, disciplinary actions, and interviews.
  • Perform financial analysis by monitoring the profitability of managed care contracts; coordinating contract modeling initiatives with internal finance and Franciscan Alliance resources to make managed care contract renewal recommendations and prepare financial modeling for new or renewal contract opportunities.
  • Prepare, implement, and monitor department strategic plan, goals and performance targets; and conduct needs analysis and submit capital requests to create a long-range plan that supports the organization and department success.
  • Supervise the work of others and manages the performance of individuals through feedback and recommendations.
WHAT IT TAKES TO SUCCEED
  • Prior management experience in a managed care consulting or healthcare environment with proven ability to lead physicians and healthcare administrators to a consensus.
  • Prior experience in network development and management/contracting experience, including rate analysis and negotiations required. 
  • Analyze and synthesize complex quantitative information.
  • Knowledge of billing and collection systems. 
  • Critically evaluate and analyze information in written materials.
  • Develop effective relationships with patients, hospital departments, and other external parties.
  • Customer service skills.
  • Knowledge of laws, regulations, or policies impacting the Healthcare industry.
  • Manipulate data and develop reports.


WHAT WE'RE LOOKING FOR

 

5-10 Years Experience

License(s): Not Applicable

Certification(s): Not Applicable

Travel: Never or Rarely

 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

LEADERSHIP ​​​​


Nearest Major Market: Gary
Nearest Secondary Market: Chicago