Provider Contract Manager

Kaiser Permanente; Burbank (CA); On-site; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a skilled Contract Manager to oversee provider relations and contract negotiations. In this pivotal role, you will manage the entire contracting process, from sourcing providers to negotiating competitive contracts. You will analyze cost data to develop effective contracting strategies while ensuring compliance with industry regulations. Your expertise in financial analysis and problem-solving will be crucial in maintaining high-quality standards and fostering strong relationships with providers. This opportunity offers a chance to make a significant impact in a dynamic environment focused on improving healthcare delivery.

Qualifications

• 5+ years of experience in managed care provider contracting or relations.
• Bachelor's degree or equivalent experience required.

Responsibilities

• Manage contract negotiations and ensure compliance with regulations.
• Collaborate with stakeholders and monitor network performance.

Skills

Contract Negotiation

Problem-solving

Financial Analysis

Regulatory Compliance

Education

Bachelor's degree

High School Diploma or GED

Tools

MS Word

MS Excel

MS Access

MS Visio

MS PowerPoint

Job description

Preferred work location is Southern California, Colorado or Washington.

Please Note: Salary ranges are geographically based, and the posted range reflects the Northern CA region. Lower salary ranges will apply for other labor markets outside of NCAL.

Job Summary:

Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring, monitoring, and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cost and competitive data for the development of contracting strategies.

Essential Responsibilities:

• Contract Negotiation: Negotiates financially competitive and predictable contracts. Participates in collaboration with Actuarial Services and internal advisors when appropriate. Evaluates multiple suppliers through a pre-screening process to evaluate a supplier's opportunity to provide the best quality, price, and service, including reviews of supplier dependability and financial solvency.
• Determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.
• Prepares a business profile for each potential supplier, indicating the solvency and credit-worthiness of the supplier and checking for any potential problems in the supply chain.
• Servicing Regional Stake Holders: Responsible for communications, assessments, identifying network needs, strategy development, financial implementation, forecasting, etc. Facilitates and directs stakeholder meetings and communications.
• Collaboration & Coordination with Provider Relations: Includes provider implementation, communications, maintenance of provider contract files, provider database, provider training, and system configuration quality control.
• Network Monitoring: Responsible for generating or coordinating the development of metrics, including financial analysis, supplier oversight, network adequacy, member satisfaction, supplier integrity, business continuity, product recall, etc.
• Regulatory Compliance: Ensures regulatory and statutory compliance of provider contracts and executes remediation efforts as determined by senior contract managers and leadership.

Basic Qualifications:

Experience

• Minimum five (5) years relevant experience.
• Minimum three (3) years of managed care provider contracting or provider relations experience.

Education

• Bachelor's degree, OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements:

• MS Word, Excel, Access, Visio & PowerPoint.
• Thorough knowledge of provider contracting policies, practices, and systems.
• Complete understanding and broad application of principles, theories, concepts, practices, and standards in contract negotiation strategies and techniques.
• Full knowledge of health care industry content practices.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

• Minimum five (5) years of managed care provider contracting, or provider relations management experience preferred.
• Minimum two (2) years of health plan operations cross-functional experience preferred.
• Master's degree preferred.