Provider Contracts Manager
Apply NowCompany: Gold Coast Health Plan
Location: Camarillo, CA 93010
Description:
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
Work Culture:
GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.
GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).
GCHP's focuses on 5 Core Values in the workplace:
Integrity
Accountability
Collaboration
Trust
Respect
Disclaimers:
Flexible work schedule is based on job duties, department, organization, or business need.
Gold Coast Health Plan will not sponsor applicants for work visas.
POSITION SUMMARY
Under the direction of the Director, Provider Network Ops, Program and Policy, the Provider Contract Manager will participate in and may lead less complex contract administration initiatives for creating and managing contract templates used across the organization. They will ensure consistency and compliance with legislative and regulatory requirements as well as maximize operational efficiency and provider relationships. They will serve as subject matter expert for contract language, developing contract language tools and solutions for the provider contracting staff.
Amount of Travel Required: as needed; typically 3-5%
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
ESSENTIAL FUNCTIONS
Oversee Provider Contract relationships
Provide strategic direction in contract negotiations
Analyze contract issues to optimize value
Lead efforts in risk assessment and process improvement
Work closely with business partners to develop effective contracting strategy
Draft review, analyze and prepare various types of contracts, renewals and amendments according to regulatory guidelines and under appropriate legal supervision.
Works closely with Legal and Sr. Management to ensure that contracts meet all federal, state, and regulatory requirements as well as operational efficiencies and other high-value business needs.
Leads efforts to optimize language for various types of contracts and special use contracts.
Serves as subject matter expert around contract language in response to RFPs, audits, and legal clarifications.
Makes recommendations to contract modifications and presents to Sr. Leadership for Executive committee approval.
Works with contract specialists to identify best practice solutions to contract needs and mentors contract specialists on contract language impacts.
Manages the development and implementation of the organizations contract management/administration strategies, processes, and systems.
Leads reviews to ensure that contract terms and language can be implemented efficiently.
Researches and quantifies impact to contract modifications.
Manages the development and maintains tracking software or reporting.
Act as a liaison between delegates and internal departments
Manages special contracting projects and assignments
Manage Medicare and Cal Aim contracts to include the contract repository, along with leading special projects.
Negotiate contracts
Policy implementation to fellow team members.
Collaborate with management for approval or amendments in, procedures and policies.
Communicate with internal & external stakeholders regarding project goals and expected deliverables.
Resolving project-related problems within their area of expertise.
POSITION QUALIFICATIONS
Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
Interpersonal - Ability to get along well with a variety of personalities and individuals.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Communication, Oral - Ability to communicate effectively with others using the spoken word
Communication, Written - Ability to communicate in writing clearly and concisely
SKILLS & ABILITIES
Education: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Business, Healthcare Management or related field preferred
Experience:
8+ years of provider management experience specific to physician, hospital, ancillary, and health plan contracting
5 of experience with varying payment methodologies and value base contracting, such as: Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case
5 of experience of Medi-Cal and Medicare value based / risk based contracting arrangements
Computer Skills: Proficient computer skills in MS Office products, Excel, Word Outlook , PowerPoint,
Certifications & Licenses: A valid and current Driver's License
Other Requirements:
Strong experience using analytical thinking skills and demonstrated ability to exercise sound judgment when making decisions
Strong Understanding of Medical terminology, related procedures and diagnostic coding, and knowledge of how to access available resource tools
Strong understanding of State of California Governmental Programs Contract Requirements and Reimbursement Methodology and Medicare Contract Requirements and Reimbursement Methodologies
Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology
Strong Presentation Skills to effectively present information to internal and external key stakeholders.
Strong Ability to Coordinate, delegate and supervise the work of others
Understanding of SharePoint and metadata
Work Culture:
GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.
GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).
GCHP's focuses on 5 Core Values in the workplace:
Integrity
Accountability
Collaboration
Trust
Respect
Disclaimers:
Flexible work schedule is based on job duties, department, organization, or business need.
Gold Coast Health Plan will not sponsor applicants for work visas.
POSITION SUMMARY
Under the direction of the Director, Provider Network Ops, Program and Policy, the Provider Contract Manager will participate in and may lead less complex contract administration initiatives for creating and managing contract templates used across the organization. They will ensure consistency and compliance with legislative and regulatory requirements as well as maximize operational efficiency and provider relationships. They will serve as subject matter expert for contract language, developing contract language tools and solutions for the provider contracting staff.
Amount of Travel Required: as needed; typically 3-5%
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
ESSENTIAL FUNCTIONS
Oversee Provider Contract relationships
Provide strategic direction in contract negotiations
Analyze contract issues to optimize value
Lead efforts in risk assessment and process improvement
Work closely with business partners to develop effective contracting strategy
Draft review, analyze and prepare various types of contracts, renewals and amendments according to regulatory guidelines and under appropriate legal supervision.
Works closely with Legal and Sr. Management to ensure that contracts meet all federal, state, and regulatory requirements as well as operational efficiencies and other high-value business needs.
Leads efforts to optimize language for various types of contracts and special use contracts.
Serves as subject matter expert around contract language in response to RFPs, audits, and legal clarifications.
Makes recommendations to contract modifications and presents to Sr. Leadership for Executive committee approval.
Works with contract specialists to identify best practice solutions to contract needs and mentors contract specialists on contract language impacts.
Manages the development and implementation of the organizations contract management/administration strategies, processes, and systems.
Leads reviews to ensure that contract terms and language can be implemented efficiently.
Researches and quantifies impact to contract modifications.
Manages the development and maintains tracking software or reporting.
Act as a liaison between delegates and internal departments
Manages special contracting projects and assignments
Manage Medicare and Cal Aim contracts to include the contract repository, along with leading special projects.
Negotiate contracts
Policy implementation to fellow team members.
Collaborate with management for approval or amendments in, procedures and policies.
Communicate with internal & external stakeholders regarding project goals and expected deliverables.
Resolving project-related problems within their area of expertise.
POSITION QUALIFICATIONS
Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
Interpersonal - Ability to get along well with a variety of personalities and individuals.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Communication, Oral - Ability to communicate effectively with others using the spoken word
Communication, Written - Ability to communicate in writing clearly and concisely
SKILLS & ABILITIES
Education: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Business, Healthcare Management or related field preferred
Experience:
8+ years of provider management experience specific to physician, hospital, ancillary, and health plan contracting
5 of experience with varying payment methodologies and value base contracting, such as: Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case
5 of experience of Medi-Cal and Medicare value based / risk based contracting arrangements
Computer Skills: Proficient computer skills in MS Office products, Excel, Word Outlook , PowerPoint,
Certifications & Licenses: A valid and current Driver's License
Other Requirements:
Strong experience using analytical thinking skills and demonstrated ability to exercise sound judgment when making decisions
Strong Understanding of Medical terminology, related procedures and diagnostic coding, and knowledge of how to access available resource tools
Strong understanding of State of California Governmental Programs Contract Requirements and Reimbursement Methodology and Medicare Contract Requirements and Reimbursement Methodologies
Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology
Strong Presentation Skills to effectively present information to internal and external key stakeholders.
Strong Ability to Coordinate, delegate and supervise the work of others
Understanding of SharePoint and metadata