Senior Manager, Contracts Network Development - 26-10
About The Position
This position is responsible for analyzing, negotiating, and implementing new HMO, PPO, ACO, physician group, and ancillary contract terms across multiple lines of business to include Commercial, Medicare, and Medi-Cal. This position is also responsible for the ongoing management and oversight of sub-capitation agreements to ensure compliance with financial and operational objectives and key contract terms. Works as a key partner to the Senior Director of Contracting and/or the Chief Contracting Officer in negotiating complex and often the most challenging health plan and downstream provider contract agreements. Fills in for the Senior Director of Contracting and/or the other department Contract Managers in their absence.
Requirements
- Exceptional written and verbal communication skills.
- Strong desktop application skills including Word, Excel, Power Point, Salesforce, and database management skills.
- Minimum five (5) years’ experience in managed care contracting, with experience in capitated contract environments.
- Must have working knowledge of provider & health plan contract authorization and claims payment protocols.
- Ability to identify and define work process issues and work collaboratively to find solutions.
- Strong, demonstrated financial analysis and auditing skills.
- Effective at working independently and in partnership with key internal stakeholders.
- Must be able to develop constructive and credible relationships with external business partners.
- Must be able to successfully and simultaneously manage multiple projects and deadlines.
Nice To Haves
- Masters preferred
Responsibilities
- Analyze and recommend rates and terms for health plan, ancillary and physician contract terms and take point in leading their negotiation as assigned.
- Act as liaison between Hill Physicians’ departments and the health plans, to identify problem patterns and improve communication and other processes between Hill and the health plans.
- Ensure Health Plan compliance with key contract terms, such as capitation deductions.
- Ensure providers meet key operational and financial objectives, such as cost-effective delivery of care and comply with key contract terms.
- Coordinate the efforts of internal departments to ensure appropriate administration of subcontracted services and to ensure payments are made in accordance with contract terms.
- Be accountable to the Regional Services Directors for ensuring contracts meet the overall network requirements of the region.
- Support the Senior Director of Contracting and/or the Chief Contracting Officer in generating reports and performing special projects.
- Identify opportunities for cost savings or improved contract terms throughout the network.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Number of Employees
501-1,000 employees
