Sr Manager, Contracting (Sr. Manager I)

Sr Manager, Contracting (Sr. Manager I)

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Sr Manager, Contracting (Sr. Manager I) and help shape the future of healthcare where you'll be an integral part of our Contracting team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

Under the leadership and guidance of the Director of Contracting, the Sr Manager of Contracting will be responsible for the daily management and oversight of contract negotiations, contract implementation, and contract effectiveness and staff performance. You'll perform complex contract negotiations, including delegated health networks, hospitals, specialty vendors, ancillary, professional and local government contracts consisting of capitation, fee-for-service, case rates, shared risk/full risk and other value-based/performance driven reimbursement methodologies. Additionally, you'll also collaborate with the Director and organization leadership, legal affairs, project implementation management teams and all levels of CalOptima Health staff across other departments. Finally, you'll provide guidance and oversight to staff leading contract negotiations and serve as a subject matter expert, ensuring compliance with CalOptima Health's policies, department procedures and government regulations. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Leadership Functions

• Cultivates and promotes a mission-driven culture of high-quality performance, with a focus on customer service, consistency, dignity and accountability.

• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.

• Leads a team with varying levels of contracting experience and abilities to ensure effective use of individual skills to achieve team goals and objectives.

• Hires, manages, trains, reviews and sets goals for the department and staff.

• Develops and implements corrective action plans and trains staff as needed.

• Establishes and manages teams to a set of standards and governance established by leadership to improve performance, achieve targeted outcomes and support growth.

• Tracks and trends teams performances by way of dashboards or other tools and resources.

• Identifies, recommends, negotiates and implements various provider network strategies.

• Identifies problems and evaluates, analyzes and recommends solutions.

• Develops remediation plans when contracting issues are identified.

• Represents the Contracting department in on-site and off-site meetings.

• Participates in regulatory audit presentations, when applicable.

• Manages CalOptima Health's contracted programs to industry standards, staying up to date with regulations, collaborating with internal workgroups and implementing best practices while ensuring adherence and driving improvement in outcomes.

• Maintains department's quality goals and production levels identified by leadership and ensures performance goals are consistently met and/or exceeded.

• Anticipates future demands of initiatives, strategic plans and regulatory updates and works with leadership to implement solutions that meet demands and expectations.

• 45% - Contract Negotiations and Processes

• Lead the end-to-end contracting process, provide oversight and lead projects within identified targets and timelines.

• Leads contract negotiations and supervises staff who negotiate complex provider contracts servicing CalOptima Health's Covered California, Medi-Cal, Medicare and PACE members.

• Serves as a subject matter expert for complex contract negotiations and provides guidance to staff.

• Ensures all contracts and single case letters of agreements (LOA) are drafted on board approved templates and ensures all necessary required language changes are coordinated through legal department prior to implementation.

• Oversees the single case LOA process and workflow, identifies insufficiencies and implements improvements, as necessary.

• Ensures all provider contracts and LOA are negotiated at board approved rates.

• Collaborates with Finance to ensure all financial analyses and models required to support contract negotiations are conducted timely.

• Negotiate and implement complex provider contracts and provide guidance to staff managing complex contracts negotiations.

• Manages and performs oversight for the tracking of contract negotiations and other assignments conducted by staff.

• Develops internal processes to monitor the effectiveness and performance of existing contracts and contracted networks.

• Collaborates with the Director and other leaders to develop and support contract strategies and coordinates with other functional departments to resolve provider contracting issues.

• Ensures leadership and providers are kept updated on a regular basis on the status of key contract negotiations and implementation of such contracts.

• Monitors the health care marketplace and internal utilization trends to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements in conjunction with leadership.

• 5% - Other

• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor of Science degree in business management or healthcare administration, or related field, PLUS 6 years of experience negotiating IPA, hospital, professional or ancillary provider contracts for commercial/Covered California, Medi-Cal and Medicare Advantage Managed care plans and/or at a Managed Care Organization (MCO) 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.

• 6 years of experience negotiating various reimbursement methodologies and value based contracting strategies, including but not limited to, shared risk/full risk/dual risk/global risk and value-based provider contracts, capitation, fee for service, per diem and case rates required.

• 3 years of progressive leadership experience, including direct supervision of staff required.

You'll Stand Out More If You Possess the Following:

• Master's degree in business management or healthcare administration.

• 2 years of experience in provider network operations and/or provider relations.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• 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.

Your 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

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.

• Our current hiring range is: Pay Grade: 316 - $120,881 - $193,410 ($