Senior Contracts/Network Manager 24-85

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At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Reporting to the Director of Contracting, this position is responsible for analyzing, negotiating, and implementing new HMO, PPO Clinically Integrated Network (CIN), ACO, Professional Provider and Ancillary contract terms. This position is also responsible for the ongoing management and oversight of sub-capitation agreements, as applicable, to ensure compliance with financial and operational objectives and key contract terms. Tis position works as a key partner to the Director of Contacting and/or Chief Contracting Officer in negotiating complex and often the most challenging Health Plan, Professional Provider, and Ancillary contract agreements. This position provides subject matter expertise and developmental management coverage/assistance for the Director of Contacting in his/her absence.

Job Responsibilities

• Analyze and recommend rates and terms for HMO, PPO Clinically Integrated network (CIN), ACO, Ancillary and Professional Provider contract terms and take point in their negotiation.

• Act as liaison between Hill Physicians' departments and the health plans, to identify problem patterns and improve communication and other processes between Hill and the plans.

• Ensure Health Plan compliance with key contract terms, such as capitation deductions.

• Ensure providers meet key operational and financial objectives, such as the cost-effective delivery of care and compliancy with key contract terms.

• Coordinate the efforts of internal departments to ensure appropriate administration of subcontracted services, and to ensure payments are made in accordance with contract terms.

• Be accountable to the Regional Services Department Manager/Director for ensuring contracts meet the overall requirements of the region.

• Support the Director of Contracting and/or Chief Contracting Officer& in generating reports and performing special projects.

• Identify opportunities for cost savings or improved contract terms throughout the network.

• Work in conjunction with Hill Physicians Population Health and Government Programs departments to monitor compliance with Quality and Performance incentives among the different Health Plan agreements.

Required Experience

• Exceptional written and verbal communication skills. Strong desktop application skills including Word, Excel, and database management (Access, SharePoint, Salesforce, etc.) skills.

• Minimum five (5) years' experience in managed care, with experience in capitated contract environments.

• Demonstrated experience leading provider and health plan contract negotiations. Must have working knowledge of provider & health plan contract authorization and claims payment protocols.

• Ability to identify and define work process issues and work collaboratively to find solutions.

• Strong, demonstrated financial analysis skills (i.e., manipulation and presentation of modeling).

• Effective at working independently and in partnership with key internal stakeholders. Able to develop constructive and credible relationships with external business partners.

• Must be able to manage multiple projects and deadlines successfully and simultaneously.

Required Education

• Bachelor's degree

Additional Information

Salary: 135,000.00 - 155,000.00 USD Annual

Hill Physicians is an Equal Opportunity Employer