Contract Manager

2 weeks ago

Honolulu, United States Kaiser Permanente Full time

Note: Work location is on-site with flexibility and the primary location will be in-office for meetings. Residence required in the primary location state. 711 Kapiolani Blvd., Honolulu, Hawaii 96813


Job Summary:

Identifies outside service needs and opportunities to complement overall supplier relationships and care delivery. Collaborates with service chiefs and others to develop contracting strategies. Develops and maintains relationships with external care providers and suppliers. Works with individual doctors offices. Serves as a resource specialist for contracting and negotiation.



Essential Responsibilities:

    • Identifies and/or anticipates outside service needs to complement overall care delivery. Collaborates with appropriate leadership teams in development of contracting strategies and other objectives. Negotiates medical care/service and other contracts for health plan membership and hospitals. Monitors compliance with contract terms and conditions. Negotiates resolution of disputes.

    • Develops and maintains relationships with internal/external care providers. Maintains provider relations. Serves as resource specialist in contracting and negotiation.

    • Monitors external healthcare delivery marketplace and internal utilization trends. Assesses new opportunities for cost savings, alternative delivery models and financial risk sharing.

    • Develops reimbursement methodologies and understands Medicare and Medicaid reimbursement policies and regulations. Develops payment strategies.

    • Performs analysis of contracts for impact assessment and recommends changes as appropriate.

    • Ensures compliance with related regulatory requirements. Provides counsel to regional leadership and work teams on contracting issues. Provides direction in communicating contract reimbursement terms to the claims department. Provides direction regarding contract implementation.


Basic Qualifications:Experience

    • Minimum four (4) years contracting experience to include medical expense and utilization analysis or JD with one year contracting experience.

Education
  • Bachelors degree in business, finance, healthcare administration, or related field OR four (4) years directly related experience.
License, Certification, Registration
  • Driver's License (Hawaii)
Additional Requirements:
  • Demonstrated knowledge of healthcare/ commercial/business contracting, financial and policy analysis, healthcare delivery and payment systems, and competitive market strategies systems.
  • Demonstrated knowledge of Center for Medicaid -Medicaid Services payment methodologies and regulations.
  • Demonstrated knowledge of NCQA and TJC accreditation and state and federal regulatory requirements specific to healthcare organizations.
  • Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiation, interpersonal relations, oral communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation, and project management.
  • Demonstrated knowledge of and skill in word processing, multimedia presentations, spreadsheet, and database PC applications.
Preferred Qualifications:
  • Demonstrated knowledge of HMO healthcare delivery systems.
  • Contract negotiations experience.
  • Demonstrated knowledge of Kaiser Permanente systems and processes.
  • Masters degree in business, finance, healthcare administration, or related field or JD.

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