Job Description

For more details, please connect with Ibad Ullah Khan at 971-431-1753 or email at ibadk@vgroupinc.com

Client: Healthcare

Job Title: Contracts Manager

Duration: 06 Months

Start Date: ASAP

Location: 505 City Parkway West, Orange CA 92868 (Onsite)

Position Type: Contract

Interview Type: Web Interview

Working Hours: 40 Hours a Week Monday to Friday, Full In-Office (8am to 5pm)

Description:

• The Contracts Manager will be responsible for developing, maintaining and negotiating contracts with health networks, professional, ancillary, facility providers, including processing Letters of Agreement (LOA).
• The incumbent will participate in network development, physician recruitment, rate proposal analyses, negotiations and coordination to ensure appropriate and timely implementation of provider contracts and provider networks, as assigned.
• The incumbent will support contracts approved by the Board of Directors and Provider Network Operation’s leadership.

Duties & Responsibilities:

80% - Program Support

• Contracting Functions Negotiates, implements and manages provider network contracts, health networks, professional, ancillary and facility providers, as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services, reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to in-network providers, as needed.
• Maintains and reports the status of LOA dispositions, develops action plans to transition non-contracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing network-wide contract initiatives.
• Coordinates with legal, Medical Management, Provider Relations, Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problem-solve provider contracting issues.
• Negotiates, implements and manages provider network contracts, health networks, professional, ancillary and facility providers, as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services, reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to in-network providers, as needed.
• Maintains and reports the status of LOA dispositions, develops action plans to transition non-contracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing network-wide contract initiatives.
• Coordinates with legal, Medical Management, Provider Relations, Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problem-solve provider contracting issues.

15% - Administrative Support

• Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.

Minimum Qualifications:

• Bachelor's degree PLUS 4 years of experience with provider contracting, negotiation, hospital and delegated health network/medical group provider agreements or other complex provider contracts required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Experience with Medi-Cal and Medicare lines of business within a health plan or large health care delivery system required.
• Experience with Medi-Cal, Medicare fee-for-service reimbursement rates, and capitation methodologies required.

Preferred Qualifications:

• 4 years of contracting and network management experience in California with a health plan or large provider delivery system.

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