Contract Manager I

Carecentrix Phoenix , AZ 85002

Posted 3 weeks ago

Overview

Network Contract Managers drive all aspects of provider network management for an assigned geographic area, typically comprised of various states. Not the typical Network Management role, the Managers function like P&L leaders as they have direct responsibility over gross margin which impacts CCX's profitability (and resulting EBITDA). Serving as the face of CCX to our providers, Managers negotiate contracts (rates & terms), drive in-network utilization by ensuring adequate provider depth (coverage area) and breadth (line of business), and ensure high levels of provider satisfaction by treating CCX network providers (our key asset) as a client.

Responsibilities

  • Initiates, develops and manages provider contracts and senior-level provider relationships.

  • Understands and knowledgeable of the contract templates, and applicable regulations surrounding network administration and claims payments.

  • Understand and knowledgeable of individual provider contracts

  • Monitors and documents contract compliance via metrics to to ensure delivery of agreed upon terms by the provider to CareCentrix

  • Monitors, identifies, escalates, and takes action on identified deficiencies in contract performance and takes action to correct any gaps / deficiencies in quality or financial performance.

  • Build a deep localized knowledge base to inform strategic planning.

  • Build strong relationships with providers to ensure lines of communications are open and strong.

  • Leverages market and service expertise to inform strategic initiatives, new product launches and provider-based partnerships.

  • Participates in strategic and tactical initiatives led by the Network Management department

  • Collaborates and works well within both the Network Management team and other departments.

  • Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.

  • Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.

  • Accountable for assuring appropriate access to services in assigned geography

  • Accountable for gross margin targets in assigned geography

  • Accountable for network QUALITY monitoring and enforcing contract terms, administering corrective action plans and coordinating audit activities.

  • Responsible for negotiation of individual provider contracts with goal of managing to our "standard template terms". Responsible for securing appropriate med-econ and legal approval for negotiations outside of the terms.

  • Responsible to address network leakage concerns for all clients.

  • Responsible for coordinating CCX communications with the provider.

  • Responsible for maintaining current contact list is CCX standard format / systems

  • Responsible for maintaining current service code / zip code information for providers.

  • Responsible to facilitate with the credentialing team and the onboarding team to ensure positive provider experience.

  • Responsible for following or standard fee schedule update process and for assuring accuracy of same.

Qualifications

  • Bachelor's Degree with two or more years of experience or 4+ years of direct healthcare experience in provider contract or relationship management required.

  • Must be familiar with modern office equipment and must be highly proficient in Microsoft Office.

  • Requires rigorous critical thinking and independent judgment

CareCentrix maintains a drug-free workplace in accordance with Florida's Drug Free Workplace Law.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

Options


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Contract Specialist

Department Of The Navy

Posted 3 days ago

VIEW JOBS 4/19/2019 12:00:00 AM 2019-07-18T00:00 * Duties Help Duties Summary You will serve as a Contract Specialist in the DEPARTMENT OF THE NAVY. THIS IS AN EXPEDITED HIRING AUTHORITY ANNOUNCEMENT. The Duncan Hunter National Defense Authorization Act (NDAA) FY 2009 provides that the Secretary of Defense can designate acquisition positions as shortage positions and recruit and appoint highly qualified persons to these positions. Learn more about this agency Responsibilities * Duties and responsibilities vary and increase according to grade level. Travel Required Occasional travel - You may be expected to travel for this position. Supervisory status No Promotion Potential None * Job family (Series) 1102 Contracting * Requirements Help Requirements Conditions of Employment * Must be a US Citizen. * Must be determined suitable for federal employment. * Must participate in the direct deposit pay program. * New employees to the Department of the Navy will be required to successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit www.dhs.gov/E-Verify/. * Within the Department of Defense (DoD), the appointment of retired military members within 180 days immediately following retirement date to a civilian position is subject to the provisions of 5 United States Code 3326. * You may be required to successfully complete a pre-appointment physical examination. * You will be required to obtain and maintain an interim and/or final security clearance prior to entrance on duty. Failure to obtain and maintain the required level of clearance may result in the withdrawal of a job offer or removal. * This position is covered under the Defense Acquisition Workforce Improvement Act (DAWIA) and requires additional education, training and experience. Positions may be in any DAWIA Career Field at Level I, II, or III. * This position may be designated Critical Acquisition Position (CAP). You must be a member of the Acquisition Corps, become a member, or obtain a waiver at the time of selection and sign a three-year tenure agreement prior to assuming the position. * Successful completion of a pre-employment drug test (including marijuana) may be required. A tentative offer of employment will be rescinded if you fail to report to the drug test appointment or pass the test. You may be subject to random testing. * You may be required to complete ethics orientation within three months of appointment and submit a Confidential Financial Disclosure Report, OGE-450, within 30 days of appointment. * Supervisors in the executive branch have a heightened personal responsibility for advancing government ethics. Those selected for supervisor positions may be required to review the 14 General Principles of Ethical Conduct at 5 CFR 2635.10. * Positions selected for may or may not be under a hiring bargaining unit. * Warrant authority above the small purchase threshold may be required. Qualifications In addition to the basic education requirements, applicants must meet the following minimum qualifications: FOR THE GS-05 (or equivalent pay band): Applicants who meet the basic education requirement are automatically qualified for the GS-05 grade. GS-07: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-05 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: assembling contracts; and performing limited contract administration. GS-09: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-07 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: applying contract and procurement regulations to prepare solicitations containing appropriate provisions, clauses, terms and conditions that communicate requirements to industry. GS-11: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-09 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: 1) applying contract and procurement regulations to prepare solicitations containing appropriate provisions, clauses, terms and conditions that communicate requirements to industry; AND 2) evaluating responses to solicitations for price reasonableness, compliance with terms and conditions, and adequacy of competition. GS-12: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-11 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience is defined as experience that is typically in or related to the work of the position to be filled and has equipped you with the particular knowledge, skills, and abilities, to perform successfully the duties of the position. Specialized experience must demonstrate the following: applying contract and procurement regulations to prepare solicitations containing appropriate provisions, clauses, terms and conditions that communicate requirements to industry; evaluating responses to solicitations for price reasonableness, compliance with terms and conditions, and adequacy of competition; administering contracts to include contract scope determinations, contract modifications, supplemental agreements, justifications, approval reviews/fair opportunity evaluations and claims disputes, and contract terminations. GS-13: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-12 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: applying contract and procurement regulations to prepare solicitations containing appropriate provisions, clauses, terms and conditions that communicate requirements to industry; evaluating responses to solicitations for price reasonableness, compliance with terms and conditions, and adequacy of competition; conducting acquisition planning and contract pre-award functions to include: determining method of procurement and contract type, documenting the acquisition strategy, and obtaining appropriate approvals; administering contracts to include contract scope determinations, contract modifications, supplemental agreements, justifications, approval reviews/fair opportunity evaluations and claims disputes, and contract terminations; AND interpreting and applying relevant laws, regulations, policies, standards, or procedures to specific contracting issues. GS-14: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-13 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: planning, establishing, or reviewing contracts, programs, policies, or procedures; negotiations techniques to conduct contract negotiations and deal with high level business and industry. GS-15: Applicants must also possess at least one year of specialized experience at or equivalent to the GS-14 grade level or pay band in the Federal service or equivalent experience in the private or public sector. Specialized experience must demonstrate the following: developing acquisition strategies and directing or managing procurements; and providing staff advisory services in one or more of the specializations in this occupation, AND overseeing contractual actions and phases of the contract program. Additional qualification information can be found from the following Office of Personnel Management website: https http://www.secnav.navy.mil/donhr/Documents/CivilianJobs/DoD_Qualification_Standard_For_GS-1102.pdf Individual Occupational Requirements link: https: https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/1100/contracting-series-1102/ Education Applicants must meet the following Basic Education Requirements of the Department of Defense Qualification Standard for Contracting Positions: A. A bachelor's degree from an accredited educational institution authorized to grant baccalaureate degrees AND B. At least 24 semester hours in any combination of the following fields: accounting, business, finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, or organization and management. (This requirement can be obtained within the bachelor's degree or in addition to the degree.) NOTE: The education requirements listed above apply only to individuals entering DoD 1102 positions on or after October 1, 2000. Current civilian personnel in DoD, who occupied GS-1102 positions or contracting positions with authority to award or administer contracts above the simplified acquisition threshold in an Executive Department on or before September 30, 2000, are exempt from meeting this requirement. Current military members who occupied a similar occupational specialty to the GS-1102 on or before September 30, 2000, and members of the Contingency Contracting Force are also exempt from meeting this requirement. NOTE: Education and experience may be combined for all grade levels for which both education and experience are acceptable. FOR THE GS-07- have successfully completed one full academic year of graduate education or law school or superior academic achievement with 24 hours in one or a combination of the following fields: accounting, business finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, and organization and management. FOR THE GS-09- have a master's or equivalent graduate degree or LL.B. or J.D. OR I have successfully completed two full years of graduate level education in one or a combination of the following fields: accounting, business finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, and organization and management. FOR THE GS 11- have successfully completed a Ph.D. or equivalent doctoral degree in any combination of accounting, business, finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, or organization and management. Applications will be accepted from students who expect to complete qualifying education within 9 months from the date of application. If you expect to complete your education within 9 months, please respond to the questionnaire items as if you had already completed your education. We are required to verify that the education has been completed successfully before any applicant can be appointed (report to work). Department Of The Navy Phoenix AZ

Contract Manager I

Carecentrix