Manager, Provider Contracts

Summary

Under the general direction of the Sr. Manager, Provider Network Operations (PNO, the Manager, Provider Contracts is responsible for leading the contract negotiation, provider network development, and maintenance efforts for the MedPOINT Management (MPM) managed client IPAs. This includes but is not limited to supporting the department in developing, analyzing, and implementing agreement strategies for the many types of healthcare and support service providers that result in high quality and value-based provider networks. This role ensures that all agreements are compliant with State and Federal requirements, and all Health Plan, State and Federal reporting requirements are delivered accurately. The Manager, Provider Contracts is also responsible for the management of the Contracts team to lead, develop, and maintain positive contractual and overall professional relationships with Client IPA providers. 


Duties and Responsibilities

  • Organize, supervise, coach, train, support, and evaluate Contracts Team in day-to-day duties 
  • Responsible for the quality and continued improvement of all aspects of the contract lifecycle, including recruiting, negotiating, and contracting with physicians and other healthcare service providers
  • Perform on-going assessments of Provider networks and network adequacy and make recommendations for strategic initiatives, goals, and objectives
  • Conduct on-going assessment of contract rates and identify opportunities to align with current market standards and performance across specialty disciplines
  • Lead the analysis of new contract requests (LOI) and develop proposals as appropriate
  • Investigate, respond, and resolve Provider concerns regarding contract performance
  • Ensure contract templates are compliant with all regulatory requirements
  • Collaborate with the Compliance department to ensure the timely and accurate delivery of provider contract related audit requests
  • Ensure accurate responses to health plan and State regulatory deliverables
  • Develop and maintain processes that provide timely notification of critical contract events
  • Build and maintain positive provider relationships that foster a collaborative approach to quality care, network stability and cost containment
  • Manage and delegate special projects as they arise (e.g. rate analysis, language comparison)
  • Proactively develop positive working relationships with other MPM departments and staff to resolve provider issues
  • Ensure ongoing communication to department leadership, about key projects, goals, challenges, and barriers to assure timely and effective issues escalation
  • Attend provider meetings, as needed
  • Ensure HIPAA compliance is always observed/performed
  • Understand and follow the MPM Employee Handbook policies and procedures
  • Perform additional duties/assignments as needed

Minimum Job Requirements

  • Bachelor's degree in Business, Healthcare Management or related field 
  • 7+ years of experience in healthcare contracting with management and supervisory experience a must
  • Project management experience
  • Substantive knowledge of the HMO marketplace including Medi-Cal, Commercial, and Medicare
  • Familiarity with providers in within MPM network geography
  • Familiarity with MSO and Health Plan Managed Care contract strategies

Skills and Abilities

  • Strong written and verbal communication skills with internal and external stakeholders
  • Ability to maintain multiple priorities and deadlines, with strong follow through
  • Demonstrated planning, analytical, and organizational skills
  • Ability to work independently as well as take direction
  • Willingness take on and lead projects outside the normal scope of the job description
  • Strong customer service acumen with the ability to resolve complaints and concerns

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