Group Health Fund Manager

Your role at St John of God Health Care

You will lead be integral in partnering with our executive, key funding stakeholders, and those that influence either directly or indirectly, patient outcomes. In doing so you will engage across a full spectrum of assess the opportunity, provide analysis and guidance, support contract negotiation, operationalise, and monitor performance and compliance for the St John of God Health Care, consistent with identified organisational objectives. Working as part of a team, this role also interacts with contract related data outputs including clinical coding and billing across the revenue cycle continuum.

The Position- Plan, develop and manage to continually improve contract negotiation strategy, interpretation and performance for SJGHC; expanding knowledge coverage to hospital executive/caregivers and key stakeholders.- In conjunction with operational teams, analyse public care opportunities and needs to complement overall relationships and care delivery across our hospitals.- Pro-actively build and maintain positive relationships with health funds, local, state or Commonwealth government funders and St John of God Health Care (SJGHC) acting as a support to hospitals on contract compliance matters including interpretation, claim dispute and internal and external audit processes.- Work collaboratively with an experienced team of caregivers engaging in decision support strategies across all functions of funding including operationalising contract requirements and ensuring processes are in place across the revenue cycle that ensure compliance.- Work with key areas of SJGHC and funders to develop/simplify contract rules, payment models and audit expectations.- Assist with the provision of advice &/or work on projects with hospitals, funding partners or other key stakeholders that require knowledge of legislative frameworks, public health regulations and State/Commonwealth licensing requirements in the establishment of proposed new services/activities, inclusive of funding linked requirements (e.g. tenders, quality reporting to funders).- Further develop reporting of contract performance to ensure outcomes are beneficial to SJGHC’s objectives.- Be able to, or assist in reviewing data and write reports, including the use of costing data for the development of negotiation strategy where applicable.- Work with hospitals to increase accurate data capture and input in areas that drive compliance.- Assist research and provide information for use in patient care, clinical and hospital evaluations.- Facilitate evidence based best practice processes - contracting, compliance, coding, and key performance indicator development, ensuring identified issues have planned interventions to prevent reoccurrence.- Knowledge of APRA Private Health Insurance Data and ability to use the information- Convey clearly the interpretation of health data analysis, be familiar with private hospital reimbursement models, public funding models and benchmarking systems in the context of funding and other purposes for which it is used. Application of your knowledge of funding models and processes and their importance to stakeholder relationships, including public sector and national bodies is demonstrated in your presentations- Assist the Group Health Funding team to ensure compliance with all applicable contracts, national accreditation standards, and group policies.- Ensure compliance with relevant legislation and guidelines for example: Private Health Insurance Act (Cth), National Health Act (Cth), Privacy Act (Cth), Evidence Act (Cth), Australian Competition and Consumer Act (Cth), relevant State Health Acts Australian Standards, NCSQHS, Accreditation or other regulations, rules as applicable to this role.

You are a driven individual, who can work both collaboratively and autonomously to deliver outcomes. You thrive in an environment which allows for lateral thinking and you understand the value of internal and external relationships required to drive outcomes and changes in an organisation. You will have strong commercial understanding with proven experience in large contract negotiations with solid grounding in funding mechanism and commercial terms traditionally used in provision of health services/funding contracts along with highly developed influencing/negotiation skills, with an understanding of timeframes, process and achieving key deliverables.

To succeed you will possess a Master/Bachelor of Health Sciences (Nursing, Health Information or other discipline with relevant health experience) or a related management degree with a minimum of 5 years’ postgraduate experience. It is essential you have the ability to travel intrastate and interstate when required (regional Victoria, Metro NSW, Metro and regional WA)

Above all, people will be at the core of everything you do committing to and supporting our Mission and Values.

We can offer you- Salary $221,345 to $245,919 per annum plus 11.5% Supera