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Healthcare Operations Strategist

1 week ago

Auckland, Auckland, New Zealand Cooper University Health Care Full time

About Us

At Cooper University Health Care, our commitment to delivering exceptional healthcare starts with our team.

We strive to provide a work environment that fosters continuous discovery of clinical innovations and enhanced access to cutting-edge facilities, equipment, technologies, and research protocols.

Our comprehensive benefits program includes health, dental, vision, life, disability, and retirement options, ensuring the well-being of our employees.

We also offer attractive working conditions and opportunities for career growth through professional development.

Discover Why Cooper is the Employer of Choice in South Jersey

Job Summary

This key member of our Leadership Team will lead the development and implementation of managed care and direct marketing policy and strategy, driving economic benefits in the marketplace from the collective strength of our system.

The ideal candidate will participate directly with Health System Leadership, Affiliates, and Medical Groups to develop and implement these strategies.

This role has overall responsibility for the system's functions and duties related to provider networks, payer contracting, and direct marketing.

The incumbent will be responsible for establishing organization-wide processes to meet our goals.

Key Responsibilities:

  1. Plan, develop, direct, manage, and coordinate all aspects of the network and direct marketing as they relate to outside commercial contracting, provider contracting, and relationships with payers, providers, employers, and the community.
  2. Lead and manage the commercial contracting provider network and payer contracting process for all entities.
  3. Coordinate clear internal communications and ensure timely implementation of negotiated contracts with the involvement of appropriate personnel.
  4. Ensure compliance with state and federal regulatory aspects, minimizing risks to the system.
  5. Optimize Epic and Strata contract management systems for data output in reporting, creating dashboards, contract modeling, and negotiations.
  6. Verify accuracy of contract builds impacting hospital and physician A/R follow-up team workflows.
  7. Identify payer payment issues to ensure A/R follow-up collects all money due Cooper.

Requirements

5+ years of progressively responsible experience in healthcare or health plan environments, with seasoned financial and managed care contracting experience and managed care strategy development required.

Demonstrated management experience and leadership of the negotiating/contracting process, including strong organizational and prioritization skills, attention to detail, and effective communication with stakeholders.

Absolutely necessary qualifications include an in-depth understanding of the healthcare market, health plans, managed care delivery systems, and/or alternative financing systems, as well as knowledge of relevant federal and state regulations.

Experience in developing processes to ensure compliance with all relevant state and federal regulations is essential.

Strong basic financial principles, statistical, accounting, and data systems knowledge are mandatory.

Prior experience in negotiating contracts and knowledge of NCQA and URAC credentialing guidelines are highly valued.

Bachelor's Degree in Business, Finance, or Healthcare Required