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Organization TypePublic Interest
Years of Experience
Date Last Verified
Contract Manager SR The candidate identifies outside service needs and opportunities to complement overall supplier relationships and care delivery. Collaborates with service chiefs and others to develop contracting strategies. Develops and maintains relationships with external care providers and suppliers. Works with most complex organizations and large, complex contracts. Serves as a resource specialist for contracting and negotiation. Negotiates medical care/service contracts for health plan membership and hospitals. Monitors compliance with contract terms and conditions. Negotiates resolution of disputes. Develops and maintains relationships with internal/external care providers. Maintains provider relations. Serves as resource specialist in contracting and negotiation. Monitors external healthcare delivery marketplace and internal utilization trends. Assesses new opportunities for cost savings, alternative delivery models and financial risk sharing. Develops reimbursement methodologies and understand Medicare and Medicaid reimbursement policies and regulations. Develops payment strategies and understands medical claims payment requirements. Performs analysis of contracts for impact assessment and recommends changes as appropriate. Ensures compliance with related regulatory requirements. Provides counsel to regional leadership and work teams on contracting issues. Provides direction in communicating contract reimbursement terms to the claims department. Provides direction regarding contract implementation.
Qualification and Experience
The candidate should have 5+ years contracting experience to include medical expense and utilization analysis or JD degree with 3+ years contracting experience. Should have Bachelor's degree in business, finance, healthcare administration, or related field or 4+ years experience in a directly related field. Demonstrated knowledge of healthcare/commercial/business contracting, financial and policy analysis, healthcare delivery and payment systems and competitive market strategies systems is essential. Demonstrated knowledge of Center for Medicaid - Medicaid Services payment methodologies and regulation is essential. Must have knowledge of NCQA and JCAHO accreditation and state and federal regulatory requirements specific to healthcare organizations and knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiation, interpersonal relations, oral communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation and project management. Must have knowledge of and skill in word processing, multimedia presentations, spreadsheet and database PC applications. Contract negotiations experience is preferred. Master's degree in business, finance, healthcare administration or related field or JD degree is preferred. Demonstrated knowledge of HMO healthcare delivery system is preferred.
Job Number: 680963
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