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Provider Contracts Manager, Santa Barbara, CA


Organization: CenCal Health
Category: Manager
Location: Santa Barbara, CA
Date Job Posted: July 10, 2020
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Provider Contracts Manager

Manager PROVI01265
Full-Time
Santa Barbara, CA, USA

Job Details

Description

  • Evaluate and negotiate high priority physician group and facility contracts using Preferred, Acceptable, Discouraged and Unacceptable (PADU) guidelines
  • Establish and maintain strong business relationships with Hospital, Groups, and Ancillary providers
  • Engage targeted contracted providers in renegotiation of rates and/or language
  • Assist with cost contract strategies that positively affect the Medical Loss Ratio (MLR).
  • Assess contract language for compliance with CenCal’s standards and regulatory requirements and incorporates required languages into provider agreements. Reviews revised language with Legal Affairs
  • Participate in fee schedule determinations including development of new reimbursement models. Seeks input on value based payment models and new reimbursement models
  • Develop and maintain a work plan and timeline for completing contract negotiations and renegotiation's, and ensuring that contracts and amendments are implemented in a timely fashion
  • Compose, update, and oversee compliance with Provider Services Contracting policies & procedures. Maintain contracting protocols, payment matrix and tracking system
  • Develop and maintain various contract types and amendments in utilizing contract management software, ensuring consistency and accuracy
  • Participate on workgroups and committees designed to monitor member access to care, oversee expenses and utilization and provider service indicators
  • Run status reports according to Departmental procedures and oversees contract related requests resulting from State or regulatory audits
  • Conduct training of Provider Services staff regarding contracts and follows up with providers to ensure the return of all new contracts or amendments
  • Work closely with internal stakeholders, analysts, and systems configuration staff to implement provider contracts and amendments
  • Assist the department in provider recruitment and retention activities to build and maintain a robust provider network dedicated to serving populations served by CenCal Health
  • Assist the Director of Provider Services with special projects including process improvements and making recommendations for improvement of any and all procedures and systems at CenCal Health
  • Coach, provide feedback and guide others
  • Other duties as assigned

Qualifications

Skills

Required

  • Microsoft Office Intermediate

Education

Required

  • Bachelors or better in Health Administration or related field.

Experience

Required

  • Prior training and/or knowledge in in HIPPA, Knox Keene Health Care Service Plan Act of 1975, Medi-Cal, Medicare and CMS regulations
  • Familiarity with various provider payment methodologies including APR-DRG, capitation, fee for service, bundled payments, population health, and value based payment models and alternative payment methods
  • 5 years: Supervisory and management experience
  • 5 years: Experience in Managed Care Plan or Health Systems (Medicaid preferred)
  • Knowledge of Medi-Cal managed care, physician, and hospital contracting

Preferred

  • Knowledge of contract management software programs

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