Contracting and Network Development Manager

3 weeks ago

Camarillo, United States Clinicas del Camino Real, Inc. Full time

Quality Care Starts At Clinicas

This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.


JOB OBJECTIVE

The Contracting and Network Development Manager (Manager) plans, directs, and coordinates Clinicas’ policies, goals, and objectives related to contract language and rate pricing, negotiation strategy, planning and execution, revenue reconciliation, and payer and provider network relationship management. The Manager provides leadership, financial and administrative oversight of the provider contracted network as well as both managed care and non-managed care contracting and operations with commercial, Medicare, and Medi-Cal payers on behalf of the organization and other related ventures.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Manager is responsible for performing the following duties:

  • Develop and manage a portfolio of payer contracts that optimize organization revenue, margin and growth in alignment with Clinicas’ mission and strategic objectives
  • Work closely with Utilization Management and Clinical heads to identify any gaps in provider network. Use technology/software to identify gaps in the network. Pursue and negotiate consequent contracts. This will require regional travel.
  • Establish and maintain positive, appropriate relationships with market payers and network providers. Utilize communication and organizational skills to work collaboratively and credibly to achieve common objectives.
  • Work collaboratively with internal stakeholders including Operations, Finance, Claims, Utilization Management, and Credentialing to define and achieve common payer strategy and reimbursement objectives.
  • Develop and execute communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
  • Coordinate financial analysis of payer and provider contract performance and modeling projections based on alternate contract agreements with payers, providers, adverse trends, etc, and make appropriate recommendations or conclusions.
  • Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback regarding financial and/or operational issues with payers and providers.
  • Responsible to ensure contract language is in compliance with Federal, State, Industry and Clinicas’ standards and guidelines.
  • Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

EDUCATION, EXPERIENCE AND QUALIFICATIONS

Bachelor’s Degree in Business, Public Administration or a health-related field is required. Master’s in Business, Healthcare Administration or related field is preferred. Minimum 7 years in health care or managed care industry. Previous experience in the provider industry or contract management is highly preferred. Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, provider networks, hospitals and health insurance benefit plan designs. Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies. Highly developed communication and organizational skills. Experience assessing problems & implementing solutions. Reliable transportation is required.

  • Contracting and Network Development Manager

    4 weeks ago

    Camarillo, United States Clinicas del Camino Real, Inc. Full time

    Quality Care Starts At Clinicas!This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.JOB OBJECTIVE...

  • Contracting and Network Development Manager

    3 weeks ago

    Camarillo, United States Clinicas del Camino Real, Inc. Full time

    Quality Care Starts At Clinicas!This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.JOB OBJECTIVE...

  • Director, Network Operations

    1 week ago

    Camarillo, United States Gold Coast Health Plan Full time

    Job Description Job Description Gold Coast Health Plan will not sponsor applicants for work visas. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant...

  • Director of Managed Care and Network Operations

    4 weeks ago

    Camarillo, United States Clinicas del Camino Real, Inc. Full time

    Quality Care Starts At Clinicas!This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.ESSENTIAL...

  • Director of Managed Care and Network Operations

    4 weeks ago

    Camarillo, United States Clinicas del Camino Real, Inc. Full time

    Quality Care Starts At Clinicas!This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.ESSENTIAL...

  • Director, Network Operations

    2 weeks ago

    Camarillo, United States Gold Coast Health Plan Full time

    Job DescriptionJob DescriptionGold Coast Health Plan will not sponsor applicants for work visas.The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years...

  • Contracts Manager

    2 weeks ago

    Camarillo, United States Teledyne e2v Semiconductors Full time

    Be visionary Teledyne Technologies Incorporated provides enabling technologies for industrial growth markets that require advanced technology and high reliability. These markets include aerospace and defense, factory automation, air and water quality environmental monitoring, electronics design and development, oceanographic research, deepwater oil and gas...

  • Project Manager

    1 week ago

    Camarillo, United States PBS Biotech Full time

    **Company**: - PBS Biotech, Inc**Department**: **Program Management** **Position/Title**: **Project Manager (Contractor)** **Location**: - Camarillo, CA**Reporting To**: - Director of Program Management**FLSA Status**: **Salary Range**: - Contractor - $60.00 per hour**GENERAL PURPOSE** PBS Biotech, Inc. is a fast-growing privately held company based...

  • Project Manager

    1 month ago

    Camarillo, United States PBS Biotech Full time

    Job DescriptionJob DescriptionCompany:PBS Biotech, IncDepartment:Program ManagementPosition/Title:Project Manager (Contractor)Location:Camarillo, CA Reporting To:Director of Program ManagementFLSA Status:Salary Range:Contractor$60.00 per hour GENERAL PURPOSEPBS Biotech, Inc. is a fast-growing privately held company based in Camarillo, CA that manufactures...

  • Project Manager

    3 weeks ago

    Camarillo, United States PBS Biotech Full time

    Job DescriptionJob DescriptionCompany:PBS Biotech, IncDepartment:Program ManagementPosition/Title:Project Manager (Contractor)Location:Camarillo, CA Reporting To:Director of Program ManagementFLSA Status:Salary Range:Contractor$60.00 per hour GENERAL PURPOSEPBS Biotech, Inc. is a fast-growing privately held company based in Camarillo, CA that manufactures...

  • Sharepoint Developer

    3 days ago

    Camarillo, United States SMX Full time

    **This position requires a DoD secret security which requires US citizenship for work on DoD contracts.** **Essential Duties & Responsibilities** - General software development tasks - Proficient in writing technical documentation - Problem analysis, solution identification, maintaining (writing code), debugging, and testing of software tools - Attending...

  • Manager, Utilization Management

    21 hours ago

    Camarillo, United States Gold Coast Health Plan Full time

    Job Description Job Description Gold Coast Health Plan will not sponsor applicants for work visas. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant...

  • Local Contract School Services

    6 days ago

    Camarillo, California, United States Therapy Staff EDU Full time

    Therapy Staff EDU is seeking a School Services Special Education Teacher for a local contract job in Camarillo, California.Job Description & RequirementsSpecialty: Special Education TeacherDiscipline: School ServicesStart Date: 07/31/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAequor is now hiring a full-time...

  • Assistant Manager Ii

    5 days ago

    Camarillo, United States Sunglass Hut Full time

    Sunglass Hut - Assistant Manager IIDate: Jun 11, 2024Location: Camarillo, CA, US, 93010 **GENERAL FUNCTION** The Assistant Manager II is a core member of the leadership team that drives Sunglass Hut's success. The Assistant Manager II works in partnership with the Store/Multi Store Manager to oversee all the daily functions of the store, including selling,...

  • Development and Community Engagement Coordinator

    3 weeks ago

    Camarillo, United States Casa Pacifica Full time

    The Development and Community Engagement Coordinator is responsible for coordinating Casa Pacifica’s donor-related programs while overseeing educational, workplace, and outreach opportunities to engage the community in Casa Pacifica’s mission and work. The Development and Community Engagement Coordinator reports directly to the Chief Development Officer...

  • Project Manager

    4 weeks ago

    Camarillo, United States Interface Children & Family Services Full time

    **Position**:Ventura County VOAD Project Manager - Temporary Position for Leave of Absence **Exemption Status**: Non-Exempt **Rate**: $33.65/ HR **Location**: Camarillo, CA - Ventura County Voluntary Organizations Active in Disasters (VC VOAD) is a collaborative of local non-profit agencies, faith-based organizations, volunteer groups, public...

  • Manager, Utilization Management

    6 days ago

    Camarillo, United States Gold Coast Health Plan Full time

    Job DescriptionJob DescriptionGold Coast Health Plan will not sponsor applicants for work visas.The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years...

  • Local Contract Nurse RN

    2 weeks ago

    Camarillo, United States Therapy Staff EDU Full time

    Therapy Staff EDU is seeking a local contract nurse RN School RN for a local contract nursing job in Camarillo, California.Job Description & RequirementsSpecialty: School RNDiscipline: RNStart Date: 07/31/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAequor, LLC is now hiring a full-time School Nurse RN for the...

  • Sunglass Hut

    2 weeks ago

    Camarillo, United States Sunglass Hut Full time

    **GENERAL FUNCTION** The Assistant Manager II is a core member of the leadership team that drives Sunglass Hut's success. The Assistant Manager II works in partnership with the Store/Multi Store Manager to oversee all the daily functions of the store, including selling, coaching, merchandising, talent acquisition and retail excellence. **MAJOR DUTIES AND...

  • Hardware Development Engineer/Project Manager

    2 weeks ago

    Camarillo, United States ATTOLLO ENGINEERING, LLC Full time

    Attollo Engineering is a designer and manufacturer of cutting-edge infrared cameras and laser sensor systems for defense and industrial applications. Attollo has a full sensor fabricating facility and is a leading supplier of IR sensors in the defense and industrial space. Attollo believes in developing people to provide novel solutions for our customers....