What Managed Care contributes to Cardinal Health Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
Advisor, Managed Careis responsible forreviewing,auditingand negotiating existing and new Payor contracts with Health Insurance companies (ex. BlueCross, Blue Shield, IPA,etc). Reporting to the Manager, Managed Care Contracting, the Advisoris responsible formanaging legal review, policy compliance, contractretentionand administrative tracking of all various managed care payors. Advances company payor strategy andalignsnegotiation with strategy.
Responsibilities:
Negotiate and manage assignedcontracts, including initiate, plan,finalize, implement, report (written and verbal) and direct related negotiations.
Proposes contracting and pricing models and strategies using knowledge of market, local and national benchmarks, and payer market.Key member ofnegotiatingteam forcompany.
Negotiates contract language across all contracts, striving for uniformity among different contracts.
Coordinates finance, legal and operational reviews of contracts. Coordinates sign off on all proposed terms of contracts and amendments, adhering to Company contract sign off and approval processes.
Adheres to all Company processes for tracking rates and terms of all contracts.
Is a valuable member of the team based on core business subject matterexpertise, general industry knowledge and skills and interest in being a member of a team.
Consultswith other members of the Leadership Team on contract terms and updates to contracts that may apply to operational areas. Has the authority to direct and support managers with functional arearesponsibilities.
5-8 years related work payer contracting and negotiating experiencerequired.
Negotiation and Presentation Skills.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint orAccessand other web-based applications. May produce complex documents, performanalysisandmaintaindatabases.
Competencies:
Decision Making:Ability to make decisions with significant, broad implications for the management and operations of a major department or multiple departments. Participates in decisions onoverallstrategy and direction of the organization.
Problem Solving:Ability to address problems that are broad,complexand abstract, requiring substantial creativity, resourcefulness, staff engagement, Lean diagnostic techniques,negotiationand diplomacy to develop solutions.
Independenceof Action:Ability to set goals and priorities for functionalarea. May make recommendations for department policies,practicesand programs. Manager or Director provides broad guidance and overall direction.
Written Communications:Ability to communicatecomplex information in English effectively in writing to all levels of staff,managementand external customers across functional areas.
Oral Communications:Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate,motivateand persuade others.
Knowledge:Ability todemonstratein-depth knowledge of concepts,practicesand policies with the ability to use them incomplexvaried situations.
Teamwork:Ability to lead and direct multiple collaborative teams for large projects or groups both internal and external, and across functional areas. Results have significant implications for the management and operations of the organization.
Customer Service:Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas ina timelyand respectful manner.
What is expected of you and others at this level
Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects
May contribute to the development of policies and procedures
Works on complex projects of large scope
Develops technical solutions to a wide range of difficult problems
Solutions are innovative and consistent with organization objectives
Completes work; independently receives general guidance on new projects
Work reviewed for purpose of meeting objectives
May act as a mentor to less experienced colleagues
Benefits:Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
Medical, dental and vision coverage
Paid time off plan
Health savings account (HSA)
401k savings plan
Access to wages before pay day with myFlexPay
Flexible spending accounts (FSAs)
Short- and long-term disability coverage
Work-Life resources
Paid parental leave
Healthy lifestyle programs
Application window anticipated to close: 7/6/26 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidates geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.
