Description: The Judge Group is currently seeking a full time contracts manager for a fantastic healthcare client of our in Orange, CA. Below you can find a basic overview of the opportunity. If you would be interested to apply, please click on the job posting link directly.
Job Title: Contracts Manager
Location: Orange, CA
Job Type: Full Time, Monday-Friday
About the Job:
The Contracts Manager will be responsible for developing, maintaining, and negotiating contracts with health networks, professional, ancillary, and 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.
Responsibilities:
Negotiate, implement, and manage provider network contracts, health networks, professional, ancillary, and facility providers, as assigned.
Negotiate LOA for members being directed to out-of-network providers for covered services, review requests for accuracy and appropriateness, and attempt to identify opportunities to redirect members to in-network providers, as needed.
Maintain and report the status of LOA dispositions, develop action plans to transition non-contracted providers to full contracts when possible, and collaborate with other staff to monitor and expedite the credentialing/contracting process.
Optimize and maintain 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.
Manage project plans when implementing network-wide contract initiatives.
Coordinate with legal, Medical Management, Provider Relations, Finance, and OneCare Sales and Marketing to implement new and renewing provider contracts.
Monitor performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models, and financial risk sharing through contractual arrangements.
Work with leadership to identify and problem-solve provider contracting issues.
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
Again, qualified candidates are encouraged to apply directly. For additional questions, please feel free to reach out to Jacob at jmaybrier@judge.com
Thank You,
Jacob
Contact: jmaybrier@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
