Contracts Manager

2 weeks ago

Orange, United States CalOptima Full time

**Contracts Manager**

**CalOptima**

**CalOptima Health** is seeking a highly motivated an experienced **Contracts Manager** to join our team. The Contract Manager will be responsible for the developing, maintaining and negotiating contracts with county and third-party providers and professional and ancillary providers, including the ongoing management of Letters of Agreement. The incumbent will participate in network development, physician recruitment, rate proposal analyses and present proposals to the Contracting leadership. The incumbent will support contracts as assigned by the Board of Directors and Provider Network Operation's leadership.

**Position Information**:

- Department**:Contracting**:

- Salary Grade**:M - $85,000 - $141,086**:

- Work Arrangement**:Partial Telework**

**This position is eligible for telework in California.***

**Duties & Responsibilities**:

- 80% - Contracting Functions
- Manages contracting operations, provider inquiries and participates in cross-function teams to implement and resolve provider related issues.
- Negotiates and manages Medi-Cal, Medicare and Dual-Eligible contracts with the county, third-party providers and professional and ancillary providers.
- Oversees the end-to-end process for member specific Letters of Agreement (LOA) requests received from internal and external Utilization Management departments for members being directed to an out of network provider for covered services.
- Works with staff to review all LOA requests for accuracy and appropriateness and attempts to identify opportunities to redirect to an in-network provider.
- Maintains and reports statuses of LOA dispositions and develops action plans to transition non-contracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
- Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
- Manages project plans when implementing network-wide contract initiatives.
- Coordinates with legal, Medical Management, Provider Relations, Finance, and Sales and Marketing to implement new and renewing provider contracts.
- Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements. Works with leadership to identify and problem-solve provider contracting issues.- 15% - Administrative Support
- Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the teams in carrying out department responsibilities and collaborates with others to support short
- and long-term goals/priorities for the department. Develops desktop procedures, network overviews, and identifies network nuances that improve processes and workflows.- 5% - Completes other projects and duties as assigned.

**Minimum Qualifications**:

- Bachelor's degree required.
- 4 years of experience with provider contracting, negotiation, hospital and delegated health network/medical group provider agreements or other complex provider contracts required.
- Experience with Medi-Cal and Medicare lines of business within a health plan or large health care delivery system 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.

**Preferred Qualifications**:

- 4 years of contracting and/or network management experience in California with a health plan or large provider delivery system.

**Required Licensure / Certifications**:

- N/A

**Knowledge & Abilities**:

- 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.

**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 f

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