Job Description

Contract Manager - Southern California

Coordinated Regional Care, Prospect Medical Holdings

Remote, residence in Southern California

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The CRC Contracts Manager assists in the development and management of the contracting process and is responsible for analysis, negotiation and implementation of agreements/contracts to meet the financial objectives of the company. Recommends competitive rates and saving opportunities through analysis of cost comparisons and utilization data. Provides information and feedback to hospital leaders to ensure proper administration of the contracts. Interfaces with Legal, Finance, Revenue Cycle, Care Management, Patient Access and other hospital departments. Position is also responsible for working with related MSOs and Health Plans and other payors. Assists in the development and implementation of department strategies and initiatives.

Job Responsibilities/Duties

Evaluates and conducts health plan, hospital to hospital and ancillary services contract negotiations to ensure timely completion, purpose, accuracy, and profitability of reimbursement structure.

Negotiates competitive managed care health plan contracts, management services agreements, ancillary agreements, letters of agreements and other managed care contract types as assigned.

Negotiates and processes ad hoc and out of network health service requests, per policy, on a regular and time-sensitive basis; works with medical management to secure a competitive financial arrangement for capitated members’ care.

Understands and adheres to all Federal and State Medicare/Medicaid timeliness regulations. Maintains confidentiality in accordance with hospital policies and HIPAA privacy regulations.

Maintains comprehensive understanding of managed care contracting, finance, hospital operations, and negotiation of complex reimbursement methodologies, including; capitation and fee for service arrangements for Medi-Cal, Medicare, Covered CA and Cal Medi-Connect.

Prepares and reviews redlined contract changes and recommends contract language to assure compliance with legal requirements and business objectives. Has the ability to understand necessary language and preferred language and follows the applicable national language guideline standards.

Manages contractual relationships with recuperative care and other SDOH agencies to assist with discharge planning and access to alternative support systems as needed.

Manages contract documents with internal and external parties to successfully implement managed care contracts, including but not limited to the creation and maintenance of any required databases necessary to conduct an organized and efficient logging system.

Qualifications

Minimum Education: Bachelor’s Degree required. Master’s Degree preferred.

Minimum Experience: Five (5) years of experience in a managed care organization, such as a hospital system, MSO or Health Plan required. Excellent computer literacy and proficiency – MS Office Suite – ability to navigate the Teams environment proficiently required. Significant understanding experience with hospital contracting in a Managed Care Risk, Medi-Cal and Medicare environment. Demonstrates excellent organizational skills/abilities and ability to work independently in a completely remote environment. Ability to work in an environment where there are multiple priorities and deadlines which change frequently. Ability to establish and maintain effective working relationships across the organization. Ability to maintain a work pace appropriate to the workload. Ability to effectively communicate in a clear and concise manner. Excellent written and verbal communication skills in English. Secure, quiet place to work remotely with office furniture to support a work at home environment (computer equipment will be furnished) with internet connection and bandwidth speed to accommodate a Teams environment required. Significant California hospital risk contracting experience preferred. Ability to succinctly convey complete contracting issues relating to language and financial risks and rewards preferred. Prior experience working in a remote position preferred. Prior experience working in the Teams environment and utilizing the tools within the suite to keep projects and negotiations visible and on track to timely completion preferred. Experience in a hospital negotiation setting where the Manager can take a negotiation from beginning to completion with minimal assistance preferred.

Req. Certification/Licensure: None.

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