Job Description

For more details, please connect with Ibad Ullah Khan at 971-431-1753 or email at ibadk@vgroupinc.com

Client: CalOptima Health
Job Title: Contracts Manager

Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West, Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: Web Interview

Working Hours: 40 Hours a Week Monday to Friday, Full In-Office (8am to 5pm)

Ceipal ID: CAL_HD413_IK

Position ID: 413

W2 Payrate (Without Benefits): $43.66/Hour

Department: Contracting

Description:

• CalOptima Health is seeking a highly motivated an experienced Contracts Manager to join our team.
• The Contracts Manager will be responsible for developing, maintaining and negotiating contracts with health networks, professional, ancillary, facility providers, including processing Letters of Agreement (LOA).
• The incumbent will participate in network development, physician recruitment, rate proposal analyses, negotiations and coordination to ensure appropriate and timely implementation of provider contracts and provider networks, as assigned.
• The incumbent will support contracts approved by the Board of Directors and Provider Network Operation's leadership.

Duties & Responsibilities:

80% - Program Support

• Contracting Functions Negotiates, implements and manages provider network contracts, health networks, professional, ancillary and facility providers, as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services, reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to in-network providers, as needed.
• Maintains and reports the status of LOA dispositions, develops action plans to transition non-contracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing network-wide contract initiatives.
• Coordinates with legal, Medical Management, Provider Relations, Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problem-solve provider contracting issues.
• Negotiates, implements and manages provider network contracts, health networks, professional, ancillary and facility providers, as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services, reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to in-network providers, as needed.
• Maintains and reports the status of LOA dispositions, develops action plans to transition non-contracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing network-wide contract initiatives.
• Coordinates with legal, Medical Management, Provider Relations, Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problem-solve provider contracting issues.

15% - Administrative Support

• Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Develops desktop procedures, network overviews and identifies network nuances that improve processes and workflows.

5% - Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree PLUS 4 years of experience with provider contracting, negotiation, hospital and delegated health network/medical group provider agreements or other complex provider contracts required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Experience with Medi-Cal and Medicare lines of business within a health plan or large health care delivery system required.
• Experience with Medi-Cal, Medicare fee-for-service reimbursement rates, and capitation methodologies required.

Preferred Qualifications:

• 4 years of contracting and network management experience in California with a health plan or large provider delivery system.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

• If located at the 500, 505 Building or a remote work location:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud

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V Group Inc. is an IT Services company that supplies IT staffing, project management, and delivery services in software, network, help desk, and all IT areas. Our primary focus is the public sector including state and federal contracts. We have multiple awards/ contracts with the following states: CA, FL, GA, MD, MI, NC, NY, OH, OR, PA, SC, VA, and WA, CT, TN. If you are considering applying for a position with V Group or partnering with us on a position, please feel free to contact me with any questions you may have regarding our services and the advantages we can offer you as a consultant.


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Job Tags

Contract work, Temporary work, Immediate start, Remote job, Outdoor, Flexible hours, Weekend work, Afternoon shift, Monday to Friday,

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