Senior Advisor Contract Management and Execution

L.A. Care Health Plan•Los Angeles, CA

3d•$126,821 - $209,255

About The Position

The Senior Advisor Contract Management and Execution manages provider contracting activities from initial opportunity through final execution, including reimbursement evaluation, negotiation strategy, contract language, approvals, and renewals. The position develops and maintains contracting work plans and documentation, leads provider negotiations within established parameters, and serves as the primary contracting representative for assigned providers. The Senior Advisor identifies and addresses renewal and amendment needs, escalates risks as necessary, and communicates the health plan’s contracting positions while maintaining provider relationships and organizational integrity. The role collaborates with stakeholders to review programs, projects, processes, procedures, and policies; conducts end-to-end root cause analysis to improve outcomes and remediate issues; and helps ensure compliance with national and statewide standards and regulations. It also provides expert advice to teams such as program and product development, marketing, and customer service.

Requirements

At least 6 years of experience managing the full provider contracting lifecycle, including financial evaluation, negotiation, contract language, approvals, and renewals.
Bachelor’s degree; equivalent education and/or experience may be considered in lieu of a degree.
Strong project leadership skills, including developing and executing work plans, managing timelines, coordinating approvals, maintaining documentation, and leading negotiations.
Strong risk management skills, including proactively identifying renewal, amendment, and continuity risks.
Negotiation skills to align contract terms with organizational parameters and navigate complex agreements and negotiations.
Strong communication and relationship management skills, including communicating effectively with providers and stakeholders and fostering productive relationships.
Ability to clearly and effectively convey information.
Strong presentation skills.
Ability to analyze complex situations, data, and information to identify issues and develop effective solutions.
Ability to adjust to changing trends, industries, and client needs.
Extensive, specialized knowledge in the field.
Ability to travel to offsite locations for work.
Light physical requirements.

Nice To Haves

Master’s degree.
Experience in data analysis, understanding payment rates, and managing healthcare costs.
Advanced knowledge of managed care contracting, provider reimbursement, contract language, and health plan operations.

Responsibilities

Manage provider contracting from initial opportunity through execution, including reimbursement and financial evaluations, negotiation strategy, contract language, internal reviews and approvals, amendments, and renewals.
Develop and maintain contracting work plans and timelines, coordinate stakeholder approvals, and document contracting activity.
Lead provider negotiations and navigate agreements, exhibits, reimbursement schedules, amendments, counterproposals, concessions, and closing strategies within established organizational parameters.
Escalate proposed terms that exceed established parameters or present material risk.
Identify renewal dates, notice requirements, expiring rate terms, and amendment needs; initiate negotiations to reduce expiration and continuity risks.
Communicate contracting positions, requirements, and negotiation parameters to provider organizations.
Develop reports, analyze data, and present updates on areas of responsibility as needed.
Partner with management to communicate compliance and operational priorities and follow up with stakeholders.
Serve as the point of contact for key strategic initiatives.
Provide expert advice to business units on relevant topics within organizational standards and national and statewide compliance requirements.
Research and analyze business performance and improvement opportunities with stakeholders, document current state, identify gaps, present remediation options to leadership, and lead implementation and outcome monitoring.
Collaborate with stakeholders to review programs, projects, processes, procedures, and policies; conduct root cause analysis and remediate issues.
Perform other duties as assigned.