| Job Description & How to Apply Below | |
 Under general supervision, the Contracting Manager is responsible for developing and implementing business plans, and overseeing department operations consistent with applicable regulations, and HPSJ objectives and policies. Work is varied and complex, and requires a moderate degree of discretion and independent judgment.Essential Functions • Develops and fosters collaborative relationships with the provider communities in HPSJ’s service areas. • Develops and negotiates, or oversees the development and negotiation, of routine and complex risk and incentive contracts. • Conducts financial impact and performance analysis of proposed and existing contracts; makes recommendations and implements. • Develops and executes department objectives and action plans; monitors progress and implements appropriate interventions based on results. • Oversees contract implementation and administrative follow-through, including integration of contract acquisition and provider data maintenance activities. • Oversees the identification, research and resolution of contractual issues, including compliance, rates, reimbursement and language interpretation. • Oversees internal and external reporting. • Prepares for and oversees regulatory audits; develops and implements corrective action plans. • Develops, administers and monitors department budgets; implements appropriate interventions based on results. • Identifies the need for and oversees department implementation of department-related transaction system enhancements. • Assists in developing contracting strategies and establishing provider networks. • Hires, supervises and retains a competent staff. | |
| Position Requirements | |
| Skills / Industry Qualifications Required: | Education and Experience Required • Bachelor’s Degree in Business, Public Health Administration or related • At least five years HMO contracting experience (all provider types) • At least two years negotiating capitated and risk-based agreements (all provider types) • At least two years supervisory experience. Preferred • Supervisory experience in a contracting function. • At least two years negotiating and implementing contracts for services under state sponsored health care programs. Licenses, Registrations, Certifications • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability. Knowledge, Skills and Abilities Required • In-depth knowledge of regulatory guidelines, including Knox Keene, related to managed care and government sponsored contracting. • In-depth knowledge of contracting reimbursement models (including DRG’s), structures, components, language and payment methodologies. • Strong knowledge of managed care structures, functions and processes. • Very strong knowledge of the business, economic, demographic, and political trends and developments affecting healthcare and managed care in general, and contracting in particular. • Very strong negotiation skills, including the ability to negotiate complex service levels and rates. • Strong knowledge of contract management systems/software. • Very strong analytical skills, including financial modeling and analysis; ability to interpret and determine the impact of complex laws, regulations and other documents. • Very strong facilitation, problem solving and conflict resolution skills. • Very strong interpersonal skills, including the ability to initiate, establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ. • Very strong oral and written communication skills, including the ability to communicate professionally, effectively and persuasively both orally and in writing to diverse individuals and groups inside and outside of the organization; includes the ability to effectively explain complex information and tailor presentations to a specific audience. • Ability to commit to and facilitate an atmosphere of collaboration and team work. • Strong customer service skills. • Intermediate to advanced Word and Excel skills, including the ability to create complex formulas and templates. • Demonstrated ability to supervise staff in a manner that maximizes employee performance and business results. • Ability to handle confidential information with appropriate discretion. Preferred • In-depth knowledge of regulatory guidelines related to government sponsored contracting. |
| Education Level Required: | Bachelor |
| Experience Required to qualify for consideration: | 3 to 4 Years |
| Contact Information | |
| Contact Name: | Health Plan of San Joaquin |
| Contact Phone: | 209-461-2567 |
| Preferred method of contact: | E-mail via Apply Online Box (below when logged in) |
| Apply for this Job Here | |
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