This position is based in Southern California. The Senior Provider Contract Manager will be supporting the National Dental Contracting Portfolio. Job Summary:Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring - monitoring - and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cos... more details
Description:
This position is based in Southern California. The Senior Provider Contract Manager will be supporting the National Dental Contracting Portfolio.
Job Summary:
Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring - monitoring - and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cost and competitive data for the development of contracting strategies.
Essential Responsibilities:
Contract Negotiation: Negotiates highly complex financially competitive and predictable contracts. This includes leading collaboration with Actuarial Services and internal advisors when appropriate. Evaluates multiple suppliers through a pre-screening process to evaluate a suppliers opportunity to provide the best quality, price and service, including reviews of supplier dependability and financial solvency. As a result of the pre-screening process, may eliminate potential suppliers from consideration and further contract negotiations.
As part of contract negotiations, determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.
Prepares a business profile for each potential supplier. The profile indicates the solvency and credit-worthiness of the supplier and to check for any potential problems in the supply chain. This profile is to include: A favorable review of the List Validation and reporting (LVAR) report. A favorable Dunn & Bradstreet Report. Evidence of a robust Quality Program. A review of the Professional Liability and General Liability and Property Damage Insurance minimum limits of $1 million per occurrence, $3 million aggregate (or state regulated limits). Current Licensure, Accreditation and/or Certification.
Servicing Regional Stake Holders: Responsible for communications, assessments, identifying network needs, strategy development, financial, implementation, forecasting, etc. Leads overall responsibilities for establishing and managing stake holder relations, including coordinating and overseeing stake holder relationship activities of less senior contract managers and associate contract managers. Evaluates regional stake holder business needs, and selects, from multiple approaches, the appropriate consultative approach to ensure successful interactions and outcomes. Responsible for employing account management and customer relationship concepts and techniques to ensure service excellence.
Collaboration & Coordination with Provider Relations: This includes provider implementation, communications (provider manual, community provider portal, etc.) maintenance of provider contract files (paper & web), provider data base, provider training, and system configuration quality control. Accountable for engaging Provider Relations resources in proactively resolving interdepartmental issues.
Network Monitoring: Responsible for the analysis and evaluation of metrics, including financial analysis, supplier oversight, network adequacy (accessibility & capacity), member satisfaction, supplier integrity, business continuity, product recall, etc. and determining appropriate next steps. Oversees development of suppliers corrective action plans and ensures submitted plans meet quality and business process standards. Accountable for ensuring suppliers/suppliers are responsive to quality and service level concerns and influencing stakeholders to ensure that interventions are timely and effective.
Regulatory Compliance: Assesses new regulatory and statutory requirements that may impact provider contracts, determines necessary changes, and leads implementation of remediation efforts to ensure regulatory and statutory compliance. Responsible for leading the on-going compliance and adherence to remediation efforts and related business processes to ensure compliance. Accountable for ensuring supplier/suppliers are educated on and adhering to the KP Supplier Integrity program. Responds to audit requests for both internal and external audits and develops corrective actions plans, as appropriate. Develops and leads self-assessments for the team in anticipation of internal and external audits and proactively develops plans to ensure future audits are responded to efficiently.
Contract Management Leadership: Oversees and directs the day to day operations of the contract management unit. Responsible for peer review, coaching and development of less senior contract managers and associate contract managers. May provide input on performance evaluations and participate in goal development.
Basic Qualifications:
Experience
Minimum eight (8) years of managed care provider contracting or provider relations experience.
Education
Bachelor's degree, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
MS Word, Excel, Access, Visio & PowerPoint.
Advanced knowledge of provider contracting policies, practices and systems.
Advanced understanding and broad application of principles, theories, concepts, practices, and standards in contract negotiation strategies and techniques.
Advanced knowledge of health care industry content practices.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Minimum eight (8) years of managed care provider contracting, or provider relations management experience preferred.
Minimum six (6) years of health plan operations cross-functional experience (i.e., claims, customer service, quality & utilization management) preferred.
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