Contracts Manager - Impresiv Health

Orange, CA 92868

About the Job

Title: Contracts Manager

Duration: up to 6 months

Compensation: $43.66-$69.86/hour

Description: The Contracts Manager will be responsible for developing, maintaining and negotiating contracts with health networks, professional, ancillary, 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.

What You Will Do:

Negotiates, implements and manages provider network contracts, health networks, 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.
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. Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.
Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.
Completes other projects and duties as assigned.

You Will Be Successful If:

Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds

What You Will Bring:

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 preferred.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!

Source : Impresiv Health