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Managed Care Department

Managed Care Department. Associate/Assistant Director Responsibility. Negotiate HMO , POS, PPO and referral contractsMonitor capitated agreements to ensure financial profitabilityDevelop strategies to increase revenue from contractsImplement/monitor new

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Managed Care Department

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    1. Managed Care Department

    2. Managed Care Department

    3. Associate/Assistant Director Responsibility Negotiate HMO , POS, PPO and referral contracts Monitor capitated agreements to ensure financial profitability Develop strategies to increase revenue from contracts Implement/monitor new & existing managed care agreements Develop long term strategies to maintain market competitiveness

    4. Managed Care Department

    5. Maintains an electronic credentialing database Provides UICPG physician data to contracted payers Ensures physician credentialing goal >90% Quarterly Audits confirming accurate physician loads www.uic.edu/hsc/managedcare Credentialing Responsibility

    7. Contractual performance analysis Front-line communications with payers & referral groups Coordinates activities with internal providers Negotiates one-time contractual arrangements with Managed Care payers Physician Support Service Responsibility

    8. Managed Care Department

    9. Webmaster Responsibility Produces Physician Referral CDs Maintains/update Managed Care website Creates software for information processing Provides statistical analysis for credentialing database www.uic.edu/hsc/managedcare

    10. Managed Care Department

    11. Assistant Director of Communications Responsibility Manage human resource functions to ensure activities are conducted in compliance with the University & Medical Center Act as a liaison with University departments & UICPG to coordinate educational programs & special events Collaborate with management team to determine marketing strategies (external and internal) Conduct day-to-day business & administrative functions Manage web content and announcements

    12. Managed Care Functions - DOS: Builds & Maintains Relationships with Health Plans Creates Unique Product Offerings & Service Initiatives Contract Administration Implements New Agreements Performs Financial Assessments

    13. Managed Care Functions - DOS: Administers Contractual Performance Evaluations Oversees Capitation and Claims Management Responds to Healthcare Delivery Issues and Concerns Communicates Contract Changes & Industry News

    14. Managed Care Functions - DONTS: One-time deals for individual self-pay patients Patient phone inquiries Patient claim resolution issues (initial) Facilitation of transferring of patients

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