Contracts Manager (Health Insurance) on-site Orange CA from INSPYR Solutions

Title: Contracts Manager (Health Insurance)
Location: Orange County, CA *100% onsite work*
Compensation: $48.66 -- $69.86/Hour
Duration: 6-month contract (on-site)
Work Requirements: US Citizen, GC Holders or Authorized to Work in the U.S.

Our client in Health Insurance is seeking a highly motivated and experienced Contracts Manager to join our team. The Contracts Manager will be responsible for developing, maintaining, and negotiating contracts with health networks, and 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.

Duties & Responsibilities:
80%

• Contracting Functions Negotiates, implements, and manages provider network contracts, health networks, and 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.

• 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.
• Develop desktop procedures, and 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. 

• 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.

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

Technology is our focus and quality is our commitment. As a national expert in delivering flexible technology and talent solutions, we strategically align industry and technical expertise with our clients' business objectives and cultural needs. Our solutions are tailored to each client and include a wide variety of professional services, project, and talent solutions. By always striving for excellence and focusing on the human aspect of our business, we work seamlessly with our talent and clients to match the right solutions to the right opportunities. Learn more about us at inspyrsolutions.com.

INSPYR Solutions provides Equal Employment Opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, INSPYR Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.