Position Summary

At Stony Brook Medicine, as a Managed Care Value Based Contract Manager, you will work under the oversight of the Assistant Director of Managed Care and join a team of professionals representing Stony Brook Medicine and its Clinically Integrated Network. As a member of this team, you will play a key role in strategy, development, implementation, and ongoing management and monitoring of value based contractual agreements.

Duties of a Managed Care Value Based Contract Manager may include the following but are not limited to:

• Using demographic data, revenue PMPM, expense PMPM and MER data, develop financially advantageous managed care value based contract proposals. Provide negotiation of value based contract terms in a manner consistent with Stony Brook Medicine and its Clinically Integrated Network's strategic approach to managed care value based contracting.
• Serve as a liaison for the Managed Care Department to internal and external constituents. Facilitate value based agreement workgroup(s) that shall monitor, analyze and manage contract performance, requirements and reconciliation. Meets regularly with payer representatives and is deeply knowledgeable of all contractual agreements. Works closely with the clinical leadership team to achieve the organization's goal to support and move toward value through innovative value based contracting.
• Working in conjunction with key stakeholders, negotiate quality incentive program/value based agreement's financial risk terms. Develop financial risk models to analyze payer proposals, shared savings/shared risk, capitation, global bundled pricing and percentage of premium contracts. Assess risk exposure, potential upside and downside opportunities and coordinate feedback from key stakeholders.
• Responsible for timely renewal of all payer contracts to ensure there is no delay in reimbursements
• Oversees reimbursement from all payers.
• Participate in the development of management reporting systems to measure track and monitor the performance of the value based contracts.
• Interpret information contained in the value based contract or program manual and communicate such to applicable SBM team members. Provide education and support resources for the accurate implementation of the values based contract or program.
• Support PCMH by facilitating physician demographic updates and/or member panel roster transfers.
• Prepare reports and presentations on managed care utilization, trends and financial impact.
• Assist the Managed Care Contracting Team in the development of financially advantageous managed care compensation proposals by accurate analysis of utilization, demographic, case mix and market share data.
• Assist the Managed Care Contracting Team in negotiating managed care agreements on behalf of SBM.
• Assist the Managed Care Contracting Team with single case agreements, maintenance of databases and rate matrices.

Qualifications

Required:

• Bachelor's Degree.
• Minimum of 3 years experience with managed care value based contract negotiations and contract management.
• Experience in managing the compilation of data, and analysis of data to support value based programs.
• Experience facilitating value based joint operating meetings.
• Demonstrate project management skills and be proficient in high level database management.
• Demonstrate background in healthcare policy and health population management.
• Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities.
• Ability to follow, read and interpret managed care value based contracts and experience with leading value based reimbursement initiatives.
• Proficient in the use of Microsoft Office-Word, Excel, PowerPoint and Google software.
• Position requires contracting/negotiating, interpersonal and quantitative skills and the ability to work independently with guidance.

Preferred:

• MBA, MHP, MPA or equivalent advanced degree.
• Minimum of 5 years experience with managed care value based contract negotiations and contract management.
• Expertise with NCQA's HEDIS and CAHPS Measures and CMS Value Based Care Programs (i.e., BPCI, HACRP, HRRP, VBP, MIPS, etc.).
• Experience in negotiating commercial Managed Care agreements for medical and behavioral health services.
• Experience with managed care organization's center of excellence application process and contract negotiation.
• Experience with Single Case Agreements for out-of-network providers.

Special Notes: Resume/CV should be included with the online application.

Posting Overview: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

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• Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions may be subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Prior to start date, the selected candidate must meet the following requirements:

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen*
• Meet Regulatory Requirements for pre-employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

*The hiring department will be responsible for any fee incurred for examination.

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Anticipated Pay Range:

The starting salary range (or hiring range) for this position has been established as - $125000 - $144200.

The above salary range (or hiring range) represents SBUH's good faith and reasonable estimate of the range of possible compensation at the time of posting.

In addition, all UUP positions have an additional $3,087 for location,

Some positions offer shift differentials for Night ($3,700) & Evening ($2,500) as well as $575 for inconvenience for positions not on day shift. Please visit these links to learn more.

Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and state pension that add to your bottom line.