Contracting and 340B Program Manager

United Health Centers of the San Joaquin Valley•Fresno-Corporate, CA

About The Position

The Contracting and 340B Program Manager is an exempt position and reports to the Contracting and Managed Care Officer (CMCO). The Contracting and 340B Program Manager is responsible for overseeing developing, implementing, and overseeing innovative solutions to provide operational accountability, management and process development of the 340B program and all payer contracts. This individual will work with the CMCO to ensure that the 340B Program is compliant with organization policies and procedures. In addition, this position will manage UHC payer relationships and underlying payer contracts; and, provide leadership to department staff for contract support. Develop strategic plans for growing UHC’s contracted payer portfolio. Lead payer negotiations, mitigate out of network participating status, advance industry leading pricing logic, and deliver on key priorities as identified by the CMCO. The Contracting and 340B Program Manager will be responsible for the development, documentation, and communication of internal systems and infrastructure to facilitate the transition and implementation of payer contracts. This position shall ensure that UHC’s participation in payer contracts meets UHC's patient satisfaction, regulatory adherence, and financial standards for the health centers.

Requirements

Bachelor’s degree preferred in business administration, finance, accounting or a similar field.
Possess a valid CA driver’s license
Minimum of two years of financial experience preferred.
Two years of experience with 340B program preferred.
Strong verbal and written communication skills
Possess strong business acumen and professionalism
Proficiency with the Microsoft Office, especially Microsoft Excel
Must be able to prioritize multiple responsibilities and manage a large workload within budget and timelines.
Must have excellent problem-solving skills and self-motivation.
Must have the ability to develop alternative solutions to problems.
Must be able to prepare clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memos and other documents.
Must be able to independently plan, organize, prioritize, schedule, coordinate, and make decisions related to assigned responsibilities.
Must have a very strong customer service orientation, positive attitude, and be highly self-motivated, directed, and change oriented.

Responsibilities

Assist in the development, implementation and ongoing evaluation of the 340B Program.
Serve as the primary internal and external liaison for all 340B related matters, programs and information exchange to assure consistent system-wide performance.
Supervise staff as needed, such as 340B Program Coordinator.
Provide oversight of the 340B program across the health system, assuring compliance and providing reporting to appropriate parties.
Work with strategic partners to optimize the return of the program, including, but not limited to vendor oversight, reviewing performance reports, contractual monitoring, and regulation changes.
Develop and enhance, in collaboration with other departments, new and innovative methods for facilitating the Operations and oversight of the 340B program.
Perform complex statistical, cost, and financial analysis of data regarding the 340B program, and identify and act upon reimbursement and revenue opportunities.
Develop, champion, and implement programs and procedures to assure effective and efficient use of pharmacy resources.
Develop and maintain compliance programs with HRSA and other regulatory bodies related to 340B, including internal and external audit processes, and perform audits.
Ensure that 340B-related policies and procedures are in compliance with state, federal and other regulatory guidelines.
Generate innovative ideas which are strategically sound and challenge the status quo.
Define alternative/compromise solutions that address others’ fundamental concerns and impacts on long-term relationships and systematically convey pros and cons of alternative solutions and achieve consensus on direction/approach.
Develop and update documents, process, and policies and procedures for daily operations and monthly financial reporting and tracking.
Regularly navigate UHC’s EHR to verify 340B claims as well as process and document new 340B eligible referral claims while maintaining all files and records regarding referral claim processing.
Develop and maintain knowledge of current regulatory trends and issues within the 340B environment as well as track, trend, and report 340B pharmaceutical sales and purchases.
Develop and maintain relationships with wholesalers, manufacturers, and contract pharmacies as well as maintaining the accounting for the 340B and pharmacy services.
Work with the Contracting and Managed Care Officer to manage UHC’s Office of the Pharmacy Affairs (340B OPAIS) profile.
Prevent duplicate discounts, reversal of duplicate discounts and diversions as needed, and submit data to 340B ESP.
Guides the coordination of multiple in and out of network organizations to organize cross-function teams to address and remove functional barriers to achieve necessary patient outcomes.
Direct the implementation of new programs, staff functions and redesign systems that will improve productivity, enhance patient care outcomes, decrease costs and improve patient satisfaction.
Establish and disseminate contracting guidelines with respect to payer contractual terms, reimbursement, provider enrollment and product participation.
Negotiating contractual and reimbursement terms with market payers.
Conduct biannual reviews of provider contracts.
Review and present financial data, utilization trends and patient mix needed to negotiate and re-negotiate payer contracts.
Works to establish policies and procedures to assist UHC in maximizing contract provisions with health plans.
Works collaboratively with members of the executive/leadership teams to lead, facilitate, coordinate, and/or support projects and process improvement initiatives that enhance UHC third party payer operational efficiency.
Effectively communicates changes regarding contracted health plans for claims processing, data management and information systems, financial management, eligibility verification, specialty panel access, patient tracking provider relations, patient satisfaction and health education to staff.
Maintains an active awareness of State, Federal, County and agency initiatives that could impact UHC, help strengthen business opportunities and negotiations with health plans.
Works to communicate health plans specifics regarding claims processing, data management and information systems, financial management, eligibility verification, and specialty panel access to ensure compliance.
Works to establish procedures to assist the health center in maximizing contract provisions with health plans and programs to ensure that they are implemented successfully and that maximum reimbursement is achieved.
Develops and coordinates identified training needs of the health center staff as it pertains to contracted insurance policies and procedures and to facilitate access to training.
Supports UHC's financial focus by maintaining an active awareness of opportunities that can help strengthen the health center.
Maintain knowledge of payer products, enrollment statistics, and trends.
Supports compliance with plans by managing and maintaining UHC and provider contract information.
Assist the CMCO in contracting and implementing subspecialty programs at UHC.
Attend and actively participate in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
Attend workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
Support the overall needs of the health center by working flexible or extended hours when necessary.
Demonstrate awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.
Other work-related duties as assigned by supervisor.
Maintain confidentiality and respect for information regarding patients and other team members; abide by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.
Display a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.
Contribute to the team by promoting positive staff interaction, maintains open communication with other programs/departments.