Senior Provider Contracts Manager

PURPOSE: To recruit and maintain a high quality, cost effective provider network consistent with the strategy of the service area and the region.   This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures. In addition, Regional leaders are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments. Accountabilities: Train, develop, and manage team of contract managers including but not limited to hiring, resolution of personnel issues, development and evaluation of individual and department goals, oversight of day to day contracting responsibilities, establishment of negotiating strategy and network development strategy. Participate in service area planning and leadership teams to develop contracting targets and communicate provider issues and concerns across all service and functional areas.  Negotiate agreements with network providers in a manner consistent with market strategy utilizing approved contract templates, approved reimbursement methodologies, KP standards, and applicable regulatory laws. Monitors and assesses external environment, trends, and legislation.  Develops contract performance standards based on regional goals and national project goals and assesses individual and contract performance against those standards. Works closely with analytics, finance, marketing, claims, UM, member services, membership, benefits administration and medical group leadership to implement contracting options on time and within budget.  Uses a team-based approach to develop individual talent, build core capacities and drive results. Works with legal to develop approved contract templates and to enforce utilization of these templates.9. Work with Provider Relations to assure smooth transition from contracting to service activities10. Establishes and enforces end to end accountabilities related to contracting, configuration, claims, provider relations and reporting.  11. Develops and quantifies strategic options for network development and expansion including, but not limited to, ·  Identifying contract network options·  Establishing short and long range contractual terms·  Developing pricing models across multiple facilities, service lines, service levels and programs.·  Prioritizes specific services and markets for potential contracting·  Provides policy clarification and issue resolution ·  Maximizes contract leverage·  Develops strategic partnerships with outside providers.  ·  Prepares and submits regular reports to Executive Director and other Senior Leaders on the cost of contracted services, identifies trends and then uses a team-based approach to evaluate options for change. MINIMUM REQUIREMENTS – Relevant Years of Experience: Five years of progressively responsible experience in negotiation of health services contracting; with particular emphasis on network development, provider network operations, provider relationship management, reimbursement analysis, contract performance analysis required. Strong knowledge of health care industry and financing mechanisms, i.e., risk pools, IPA management, TPA services, claims processing, UM programs, provider contract administration, NCQA, etc required. General knowledge of legislative and government activities and marketplace issues affecting the region preferred. Education and/or Classes: Bachelor’s Degree in Business or Health Administration required. Master’s Degree preferred. Additional Information Reference Code: MD.0800315 Position Type: Full Time, Employee