Manager - Managed Care in Anderson, South Carolina at AnMed

Manager - Managed Care

Located in the heart of Anderson, South Carolina, AnMed is a dynamic, not-for-profit health system dedicated to delivering exceptional care with compassion, innovation, and integrity. At AnMed, our mission is simple yet powerful:

To provide exceptional and compassionate care to all we serve.

AnMed has been named one of the Best Employers in South Carolina by Forbes, reflecting our commitment to a supportive, inclusive, and purpose-driven workplace. Whether you're just starting your career or looking to grow in a new direction, you'll find opportunities to thrive, lead, and make a meaningful impact here.

SUMMARY

The Manager – Managed Care is responsible for leading and developing direct reports, fostering a high-performing team environment, and ensuring alignment with organizational objectives and managed care strategies. This position also oversees the Payor Issue Escalation process and the Health Plan Policy Changes process. Supports payer contracting and negotiating, reimbursement analysis, contract implementation, and performance monitoring for all system hospitals, physicians, and affiliated providers. The manager ensures compliance with contract terms and drives operational efficiency to optimize payer relationships, reimbursement, and contract performance.

RESPONSIBILITIES

Direct Leadership and Oversight

· Provides leadership and oversight to managed care team members, including recruitment, onboarding, performance management, coaching, and employee development to ensure a high-performing and engaged team.

· Oversees the Managed Care Staff and the Payor Issue Escalation process.

· Oversees the Managed Care Staff and the Health Plan Policy Changes process.

· Oversees the Managed Care Staff and the Contract Management Process.

Contract Management and Payer Relations

· Supports the negotiation of commercial, Medicaid, and Medicare Advantage contracts by developing financial models, reviewing current agreements, and Health Plan manuals for the preparation of health plan proposals.

· Maintains contract tenants and a grid of compliance for each contracted health plan.

· Works collaboratively with payers to resolve disputes and ensure contract compliance.

Financial and Operational Analysis

· Monitors payer performance and reimbursement trends against contractual expectations.

· Monitors market trends by attending health plan and health system earnings calls and providing quarterly summaries.

· Monitors and compares national health plans' quarterly financial performance through NAIC.

· Develops financial dashboards and contract compliance reports.

· Produces the semi-annual Managed Care Executive report.

Cross-Functional Coordination

· Collaborate with Revenue Cycle, Finance, Case Management, Legal, IT, and Clinical Departments to ensure smooth contract implementation and claims resolution.

· Act as liaison for revenue cycle clinical departments and physician groups requiring managed care support (e.g., rates, language, authorizations, etc.).

QUALIFICATIONS

· Education: Bachelor's Degree in healthcare administration, business administration, or a related field; Master's Degree is preferred

· Experience: Requires minimum 5 years of experience in managed care with progressive supervisory experience of minimum 3 years

· Advanced Excel and Word. Preferably, Power BI

· Preferred HFMA Certified Healthcare Finance Professional

· Managed Care Expertise: Thorough understanding of managed care principles, policies, contracts, and operations

· Leadership and Team Management: Demonstrated ability to lead, mentor, and motivate a team

· Analytical and Problem-Solving Skills: Excellent abilities to interpret complex data, analyze contract terms, identify trends, and develop solutions

· Communication Skills: Strong verbal and written communication skills for interacting with various stakeholders, including staff, providers, payers, and patients

· Other Desired Qualities: Adaptability, strong organizational skills, ability to work under pressure, and a commitment to quality and customer service

Benefits*

· Medical Insurance & Wellness Offerings

· Compensation, Retirement & Financial Planning

· Free Financial Counseling

· Work-Life Balance & Paid Time Off (PTO)

· Professional Development

· For more information, please visit: anmed.org/careers/benefits

*Varied benefits packages are available to positions with a 0.6 FTE or higher