Top Managed Care Executive jobs in Detroit, MI

Top Managed Care Executive plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Being a Top Managed Care Executive requires a bachelor's degree. Typically reports to a top management. The Top Managed Care Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Managed Care Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Managed Care Contract Reimbursement Consultant Hybrid/Remote
  • Henry Ford Health - Careers
  • Troy, MI FULL_TIME
  • GENERAL SUMMARY:

    Under minimal supervision of the Manager, independently leads financial and data analysis to evaluate rate proposals, contract terms, and health plan reimbursement. This position will proactively identify rates, methodologies, and processes that need improvement and will develop and implement solutions to optimize reimbursement. 

    PRINCIPLE DUTIES AND RESPONSIBILITIES:
    1. Manage specific payor relationships for contracting purposes. 
    2. Lead the development of financial reporting and analysis using tools such as EPSi, SQL, Epic Clarity, and Power BI to extract and analyze data for the purpose of assessing contracted rates and reimbursement methodologies.
    3. Generate proactive analysis and make recommendations to Contracting leadership based on review and identification of payer performance reporting trends. 
    4. Lead evaluation, and creation, of metrics and processes to improve and / or track rates against industry averages to identify gaps and areas for improvement. 
    5. Manage the rate review process for existing and proposed contracts to evaluate budgetary impact, verify that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated.
    6. Coordinate with contract modeling team the implementation and maintenance of contract management/pricing systems.
    7. Maintain expertise in reimbursement methodologies, payer policies, and regulatory changes as they apply to payor contracts.
    8. Manage and complete special projects and attends various meetings.
    9. Coordinate and support Contracting projects for business units across the Health System

    EDUCATION/EXPERIENCE REQUIRED:

    • Bachelor's degree in Finance, Accounting, Business Administration, Managed Care Contracting, Reimbursement, or related field. Master's Degree preferred.
    • Five to seven (5-7) years of experience in healthcare finance, managed care contracting, or reimbursement in a professional capacity including experience with various reimbursement methodologies (DRGs, per diems, fee schedules, case rates, etc.).
    • Report writing capabilities or ability / willingness to learn.
    • Strong Analytical and Critically Thinking skills (via curiosity, creativity, skepticism, and adept in use of logic) relative to accomplishing business objective and problem solving.
    • Detail oriented. Proficient in Microsoft Excel (queries, reports, pivots, What If scenarios and database mgmt. a plus).
    •  Proficient in Data extraction & reporting tools (EPSi, SQL, Clarity, etc.).
    • Excellent oral and written communication skills.
    • Strong organizational and interpersonal skills.
    •  Strong Understanding of Managed Care Reimbursement methodologies, coding, and terminology.
    Additional Information
  • 2 Months Ago

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RN Case Manager (Mustbe in Wayne OR McComb Counties)
  • Managed Staffing
  • Wayne, MI CONTRACTOR
  • The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communica...
  • Just Posted

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Lead Carbon Composite Technician
  • Managed Programs
  • Auburn, MI FULL_TIME
  • Job Title: Lead Carbon CompositeTechnician Status: Non-exempt Reports to: Plant Supervisor Position Type: Regular Full-time Job Purpose/Summary: The ideal candidate will have a strong command of compo...
  • 2 Months Ago

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Executive Director – Home Care – RN, PT, or OT Preferred
  • Oakland Home Care
  • West Bloomfield, MI FULL_TIME
  • Job Title: Executive Director, Oakland Home Care Position Summary: Oakland Home Care provides home care services to include Physical Therapy, Occupational Therapy, Speech and Language Pathology, Medic...
  • 1 Day Ago

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Airport Rental Car Fleet Driver ($15.00 per hour)
  • Managed Labor Solutions
  • Romulus, MI FULL_TIME
  • Do you enjoy working outside an office and are passionate about driving late-model cars? Need a flexible schedule plus access to DailyPay? Managed Labor Solutions (MLS), a leading nationwide rental ca...
  • 1 Month Ago

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Chief Executive Officer- DMC Adult Central Campus (Detroit Receiving and Harper-Hutzel)
  • Other Executive
  • Detroit, MI OTHER
  • MARKET SUMMARY: MICHIGAN GROUP - Detroit Market The Detroit Medical Center is one the largest academic medical centers in the United States, with a long and rich history of medical education, providin...
  • 5 Days Ago

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0 Top Managed Care Executive jobs found in Detroit, MI area

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Compliance Senior Analyst
  • Blue Cross Blue Shield of Michigan
  • Detroit, MI
  • Job Description This role is within the Government Programs Compliance team. Government Programs Compliance coordinates ...
  • 3/19/2024 12:00:00 AM

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Preconstruction Executive
  • Gilbane Building Company
  • Detroit, MI
  • Overview: Do you consider yourself to be a highly technical, strong communicator with the desire to work in a team envir...
  • 3/19/2024 12:00:00 AM

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Project Lead
  • Iconma LLC
  • Detroit, MI
  • Engagement Description: Make a difference in the lives of our Medicare members by delivering relevant and timely communi...
  • 3/19/2024 12:00:00 AM

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Principal Specialist Engineer - Equipment Performance - Transformers
  • DTE Energy
  • Detroit, MI
  • DTE is one of the nation's largest diversified energy companies. Our electric and gas companies have fueled our customer...
  • 3/19/2024 12:00:00 AM

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Clinical Social Worker
  • Corewell Health
  • Detroit, MI
  • FULL TIME-DAYS GENERAL SUMMARY: To work collaboratively with members of an interdisciplinary team in order to assist pat...
  • 3/18/2024 12:00:00 AM

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Application Developer III-Java Oracle Developer
  • Blue Cross Blue Shield of Michigan
  • Detroit, MI
  • Job Description The Information Technology department at Blue Cross Blue Shield is looking for an Application Developer ...
  • 3/16/2024 12:00:00 AM

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Engineer - Principal - Transmission Planning DTE Electric
  • DTE Energy
  • Detroit, MI
  • DTE is one of the nation's largest diversified energy companies. Our electric and gas companies have fueled our customer...
  • 3/15/2024 12:00:00 AM

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Conversion Technician - Sports/Entertainment
  • AEG
  • Detroit, MI
  • In order to be considered for this role, after clicking "apply now" above and being redirected, you must fully complete ...
  • 3/15/2024 12:00:00 AM

Detroit (/dɪˈtrɔɪt/, locally also /ˈdiːtrɔɪt/; French: Détroit, lit. 'strait') is the largest and most populous city in the U.S. state of Michigan, the largest United States city on the United States–Canada border, and the seat of Wayne County. The municipality of Detroit had a 2017 estimated population of 673,104, making it the 23rd-most populous city in the United States. The metropolitan area, known as Metro Detroit, is home to 4.3 million people, making it the second-largest in the Midwest after the Chicago metropolitan area. Regarded as a major cultural center, Detroit is known for its co...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Managed Care Executive jobs
$212,946 to $377,796
Detroit, Michigan area prices
were up 1.2% from a year ago

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