Senior Manager - Managed Care Hospital Contracting
University of California, San Francisco
Location: San Francisco, California
Internal Number: 63078BR
Reporting to the Director, Children's Contracting and Payor Strategy in UCSF Health's Department of Health Plan Strategy and Contracting, the Senior Manager - Managed Care Hospital Contracting is responsible for supporting UCSF Health's managed care contracting and related operational efforts including UCSF Medical Center, UCSF Benioff Children's Hospital San Francisco, UCSF Benioff Children's Hospital Oakland and Langley Porter Psychiatric Hospital and Clinics, and contributes to UCSF's payer contracting strategy development, locally and regionally. The Senior Manager - Managed Care Hospital Contracting also participates in the long-term management of these critical relationships. Under the supervision of the Director, the position negotiates and manages UCSF Health's medical center agreements with designated payers (i.e., commercial managed care plans, government payers, and referring medical groups in northern and central California) through direct negotiation of contract rates and associated terms for the provision of hospital services. The position also serves as the owner, relationship manager and operational liaison between these payers and internal UCSF departments who operate under the terms of UCSF Health's Medical Center and Medical Group payer contracts, including Patient Financial Services, Admitting, Care Management, Legal Affairs, School of Medicine administrators and others.
This position is also directly involved in HPS' contract modeling and supports major payer negotiations by providing negotiation support (business, legal and financial), as well as electronic medical record-based case-mix analysis of patient populations and financial assessments and payment as well as operational compliance.
The Senior Manager - Managed Care Hospital Contracting must continuously evaluate the health care market for contracting opportunities, in order to help the Director and others in HPS develop effective contracting strategies and operational improvements for its facility contracting, including highly specialized children's hospital payment programs and pricing as well as complex accountable care risk-sharing agreements. The position is responsible for the development and ongoing management of operational tools to assist various UCSF Health teams in their day-to-day operations and in the resolution of operational issues that arise between contracted payers and UCSF Health.
The Senior Manager - Managed Care Hospital Contracting must be self-directed, have excellent independent judgment, be detail-oriented, and be a quick-thinking problem solver and negotiator, applying established HPS pricing principles as well as complex UC Regent and HPS language guidelines and other standards, to protect the interests of UCSF Health (hospital and physician) in third-party payer negotiations and the associated operations. Exceptional analytical and problem-solving skills are required, as well as in-depth knowledge of the health care market, in order to assess contract financial performance and to craft rate and language terms that meet and exceed UCSF's financial targets, and are consistent with UCSF's operations, all in a rapidly evolving healthcare marketplace.
The Senior Manager - Managed Care Hospital Contracting must have excellent interpersonal and relationship management skills, communicating verbally and in writing (on both an ad hoc and ongoing basis) with clients and payers, both internal and external to UCSF. The position also serves as an expert on contracting and related operational issues and frequently facilitates the development of innovative solutions to problems that arise in the administration of UCSF's contracts.
The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and high-quality patient care. It is the only UC campus in the 10-campus system dedicated exclusively to the health sciences.