Pa Jobs in Orange County

About The Position

Requirements

• 3+ years of managed care contracting and negotiating experience involving complex delivery systems and organizations.
• Strong provider relationship management skills, with demonstrated success building long-term external partnerships.
• Knowledge of complex reimbursement methodologies, including incentive-based models (strongly preferred).
• Deep understanding of hospital, managed care, and provider business models.
• Strong presentation and communication skills, including the ability to build internal relationships in a fast-paced, matrixed organization.
• Customer-centric approach with strong interpersonal skills and comfort navigating change.
• Strong problem-solving, decision-making, negotiation, contract interpretation, and financial analysis skills.
• Proficiency in Microsoft Office.

Nice To Haves

• Bachelor’s degree in a related field (industry experience may substitute).
• MBA or MHA.

Responsibilities

• Manage complex fee-for-service and value-based contracting, reimbursements, and negotiations with hospitals and physician groups.
• Build and maintain strong provider relationships to support network growth and value-based business opportunities.
• Partner closely with matrix teams (e.g., Claims, Medical Management, Credentialing) to ensure aligned execution.
• Develop strategic network positions, identify value-based and risk-based opportunities, and contribute to alternative network initiatives and analytics.
• Meet unit cost goals while maintaining an adequate and competitive provider network.
• Design and manage initiatives to improve medical cost and quality, providing consultative guidance informed by clinical informatics.
• Prepare, review, and project the financial impact of complex contracts.
• Draft and manage healthcare provider (HCP) agreements through effective cross-functional collaboration.
• Lead the resolution of issues and manage key provider relationships, demonstrating deep knowledge of the local market landscape, including contract implementation and maintenance.
• Research problems and negotiate with partners and customers to resolve complex and escalated issues.
• Support less experienced staff as needed.

Benefits

• The internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload if working at home occasionally or permanently.