Manager External Operations - Institutional Relations

Under the direction of the director of institutional relations is responsible for managing the work of the institutional provider consultants and indirectly managing the work of the support team in the department for the purpose of building and maintaining effective working relationships with institutional providers of health care.
Has responsibility for Blue Cross and Blue Shield of Kansas provider contract maintenance to include Medicare Advantage provider agreements and TriWest contracting activities.
“This position is eligible to work hybrid after training (9 or more days a month onsite) in accordance with our Telecommuting Policy.
Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
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Essential Functions Manager is a liaison to the provider community through direct interaction with providers and supervision of institutional relations staff to support primary functions.
Supports the institutional provider contracting activities for the TriWest, the Veterans Administration facilities and Medicare Advantage provider network.
Maintains provider network contracts represented by the Competitive Allowance Program (CAP), Blue Choice, FEP, Medicare Advantage Healthy Blue and TriWest.
Up to 20% of the workday maybe spent maintaining the Medicare Advantage, Healthy Blue and TriWest provider networks and supporting institutional relations staff who are responsible for the provider education programs and maintaining the provider directories.
These networks concurrently support BlueCard, ASO groups, network purchases, and large national accounts, in addition to the Medicare supplemental products (Plan 65 & Plan 65 Select).
Manager’s primary focus is liaison with acute care hospitals, home health agencies, skilled nursing facilities, hospice facilities, inpatient and outpatient substance abuse facilities, birthing centers, dialysis centers, physical therapy/occupational therapy/speech pathology providers, ambulatory surgery centers, community mental health centers, federally qualified health centers, comprehensive outpatient rehab facilities, surgical hospitals, specialty hospitals, psychiatric hospitals, rehabilitation hospitals, critical access hospitals, rural health clinics, veterans affairs hospitals, state hospitals, and military hospitals.
Responsible for overseeing institutional relations field activity priorities related to provider education, conflict resolution, contracting and credentialing.
Provides direct input into the development of policies and procedures for the implementation in provider contracts.
Provides input to the director of institutional relations regarding medical, financial and administrative policy matters as they impact our hospital/facility community and the provider network.
Requires travel across the state including overnight stays to attend and conduct provider meetings or workshops.
Valid drivers license is required.
Must comply with the corporate compliance program.
Must follow URAC standards for essential job functions.
Must be able to maintain confidentiality.
Regular and predictable attendance is an essential job function as defined by policy.
Must comply with and implement corporate information security policies, standards, and guidelines relative to access control.
Qualifications Education: High school diploma required.
Bachelor's Degree in General Business, Accounting, Hospital Administration/Health Economics, or Marketing preferred.
Experience/Qualifications: A valid driver’s license is required.
A minimum of five years experience in the healthcare or healthcare financing field is strongly preferred .
This includes familiarity with reimbursement, research or analysis of finances within a hospital or facility, and an understanding of provider contracts, contract negotiation and applicable reimbursements.
Experience in provider relations with face to face contract negotiation is preferred.
Two years of management experience to include the direct supervision of employees required.
Two years of proven experience with project management and/or relationship management is strongly preferred.
Compensation BCBSKS Grade: Exempt 19 Minimum annual salary starting at $126,560 Salary based on education, skills and experience Posting Close Date December 8, 2023 Pay Rate Type Salary