Health Plan Contracting & Credentialing Manager

SDAIHC; San Diego (CA); On-site; USD 110,000 - 170,000; Full time

Job summary

SDAIHC in San Diego seeks a Manager of Health Plan Contracting to lead negotiations with Medi-Cal, Medicare Advantage, Covered California, and other payers to secure favorable terms and optimal PPS encounter rates for the FQHC.

You will work with Finance, Operations, Clinical Leadership and Compliance to protect Section 330 grant obligations and sliding fee integrity, serve as the California Medi-Cal policy SME, and oversee enrollment, credentialing, and contract reporting.

Qualifications

• Experience in managed care contracting and provider credentialing.
• Knowledge of FQHC PPS and Medi-Cal wrap-around payments.
• Knowledge of CalAIM program and DHCS All Plan Letters.
• Ability to interpret complex contracts and perform financial analyses.
• Experience with HRSA Health Center Program compliance.

Responsibilities

• Lead negotiations with Medi-Cal managed care plans and other payers to secure favorable terms.
• Ensure Medi-Cal contracts include compliant FQHC wrap-around provisions.
• Monitor CalAIM initiatives affecting FQHCs.
• Maintain contract management systems and renewal schedules.
• Collaborate with CFO and Revenue Cycle to model contract impact on net revenue.
• Manage payer relations and resolve disputes.
• Oversee credentialing enrollment processes and provider enrollment with payers.
• Support HRSA program compliance and annual reporting.

Skills

Negotiation

Contract interpretation

Financial modeling

Analytical skills

Communication skills

Education

Bachelor's degree or equivalent

Tools

Symplr

Modio

CredentialStream

DHCS Provider Enrollment portal

Job description

SDAIHC in San Diego seeks a Manager of Health Plan Contracting to lead negotiations with Medi-Cal, Medicare Advantage, Covered California, and other payers to secure favorable terms and optimal PPS encounter rates for the FQHC.

You will work with Finance, Operations, Clinical Leadership and Compliance to protect Section 330 grant obligations and sliding fee integrity, serve as the California Medi-Cal policy SME, and oversee enrollment, credentialing, and contract reporting.