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Organization TypePublic Interest
Years of Experience
Date Last Verified
Senior Contract Manager Responsibilities: Identifies and/or anticipates outside service needs to complement overall care delivery. Collaborates with appropriate leadership teams in development of contracting strategies and other objectives. 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
Qualifications: Bachelorâ€™s degree in business, finance, healthcare administration, or related field or 4 years' experience in a directly related field. 5+ years contracting experience to include medical expense and utilization analysis or JD with three years contracting experience. Demonstrated knowledge of healthcare/commercial/business contracting, financial and policy analysis, healthcare delivery and payment systems and competitive market strategies systems. Demonstrated knowledge of Center for Medicaid - Medicaid Services payment methodologies and regulations. Demonstrated knowledge of NCQA and JCAHO accreditation and state and federal regulatory requirements specific to healthcare organizations. Demonstrated 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. Demonstrated knowledge of and skill in word processing, multimedia presentations, spreadsheet and database PC applications. Preferred: Contract negotiations experience. Masterâ€™s Degree in business, finance, healthcare administration, or related field or JD Degree. Demonstrated knowledge of HMO healthcare delivery systems. Demonstrated knowledge of Kaiser Permanente systems and processes.
Job Number: 686364
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