Contract Manager IV, Managed Care

Sutter Health • Sacramento, CA

9d

About The Position

The position is responsible for participating in the negotiations for payer agreements for commercial and government sponsored products as assigned for Sutter hospital, professional and ancillary providers. The primary focus of this position is to support or lead payer negotiations, implementation of the managed care payer agreements and contract compliance, including performance analysis and recommendations for modifications. Additionally, assures the success of contract performance and works through any contract or claims disputes as well as support dispute litigation.

Requirements

• Bachelor's in Healthcare Administration, Business Administration or related healthcare field
• 8 years recent relevant experience
• Strong Knowledge of market imperatives, provider payment terms and trends for healthcare providers.
• Ability to perform managed care contract analysis, draft language, document review, and work with Sutter operational teams and Payer representatives to support contract compliance.
• Advanced knowledge of the operational implications of managed care contracts relative to both medical groups, ancillary providers and hospitals for all types of Payer products, commercial and government sponsored.
• An understanding of all regulatory requirements for contracting and compliance as it relates to Knox-Keene, Department of Managed Health Care, Department of Insurance, Medi-Cal, CMS, HIPAA or ERISA.
• Ability to influence and facilitate work teams to ensure the effective management of complex, multi-faceted issues, including leading operational meetings with assigned Payer representatives on behalf of Sutter.
• Skills with PowerPoint and Word.
• Ability to build consensus through effective communication skills both written and oral.
• Strong organizational skills.
• Strong knowledge of all types of provider reimbursement, including value based payments.
• Must be able to enlist cooperation and commitment to carrying out initiatives related to contract compliance or operational implementation.
• Must have the ability to maintain a high level of energy as well as the ability to work independently, prioritize multiple objectives and tasks in a rapidly changing environment and deliver quality outcomes.

Responsibilities

• support or lead payer negotiations
• implementation of the managed care payer agreements and contract compliance, including performance analysis and recommendations for modifications
• assures the success of contract performance and works through any contract or claims disputes as well as support dispute litigation

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 11-50 employees