Regional Contracts Manager

SHPCA SCAN Health Plan•Long Beach, CA

1d•$92,400 - $133,671•Hybrid

About The Position

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org , www.scanhealthplan.com , or follow us on LinkedIn ; Facebook ; and Twitter . The Job The Regional Contracts Manager shall, in concert with the Senior Regional Director and regional team develop and manage business partnership with SCAN contracted physician organizations, key hospitals, ancillary and supplemental providers to support achievement of SCAN’s goals including margin, quality measures, and achievement of our mission to enhance senior’s ability to manage their health and live independently.

Requirements

Bachelor’s Degree required or comparable combination of education/experience and/or training will be considered
5+ years managed care contracting experience required.
Capitated Contract experience required
Prior health plan experience required.
Knowledge of CMS, DHCS and other regulatory requirements required.
Strong analytic, quantitative, and problem-solving skills required.
Strong negotiation, interpersonal and presentation skills with an ability to appropriately and effectively address diverse audiences required

Responsibilities

Evaluate and negotiate contracts in a fiscally responsible manner to ensure a sustainable, high quality, compliant network for assigned region. Contracts include medical groups, IPAs, hospitals, ancillary and supplemental providers.
Work with internal business units to model expected yield, monitor actual contract performance, test the feasibility of non-template terms and conditions and follows appropriate approval process.
Establish and maintain productive business relationships with SCAN’s contracted network providers, including medical groups, IPA’s, hospitals, ancillary and supplemental providers, and ensures the network composition includes an appropriate distribution of provider specialties.
Accountable for assigned provider network performance related to financial, operational, regulatory, quality and member satisfaction targets.
Develop and execute provider specific performance improvement plans, based on needs identified via Provider Dashboard metrics that highlight operational, quality, financial and compliance based measures.
Utilize contracting knowledge for effective problem resolution and compliance.
Responsible for timely and professional interaction in response to contract related inquiries.
Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
Participate in regularly scheduled Joint Operations Committee meetings (JOCs). These meetings will discuss operational issues relative to all parties, including, but not limited to: utilization, financial, enrollment, grievances, provider termination/panel closures, continuity of care, marketing campaigns, etc.
Responsible for assuring that the day to day operations of the provider network are consistent with SCAN standards/ expectations.
Act as technical resource on contract related issues and offer strong leadership internally as well as externally.
Participate in interdepartmental meetings and selected committees and substituting for the Senior Director, Regional Network Management on an as needed basis.
Develop goals and objectives, in concert with Regional Director, Network Management that align with the organization’s vision for future growth and network development.
Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Contribute to team effort by accomplishing related results as needed.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base Pay Range: $92,400.00 - $133,671 (Annually)
Work Mode: Mostly Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!