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Regional Contracts Manager

2 months ago

Long Beach, California, United States SCAN Full time
About SCAN

SCAN Group is a not-for-profit organization dedicated to addressing the most pressing issues affecting older adults in the United States. As the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, SCAN serves over 270,000 members across California, Arizona, Nevada, Texas, and New Mexico. With a legacy spanning over 40 years, SCAN has established itself as a leading expert in senior healthcare, committed to keeping seniors healthy and independent.

Our team of talented professionals is passionate about supporting older adults on their aging journey while innovating healthcare for seniors everywhere. We provide in-depth training, access to cutting-edge tools, and development opportunities to ensure our employees excel in their roles. We take pride in recognizing our team members as experts in their fields and rewarding their efforts.

The Job

The Regional Contracts Manager will collaborate with the Senior Regional Director and regional team to develop and manage business partnerships with SCAN's contracted physician organizations, key hospitals, ancillary, and supplemental providers. This role is crucial in supporting the achievement of SCAN's goals, including margin, quality measures, and our mission to enhance seniors' ability to manage their health and live independently.

Key Responsibilities
  • Evaluate and negotiate contracts in a fiscally responsible manner to ensure a sustainable, high-quality, compliant network for the assigned region.
  • Work with internal business units to model expected yield, monitor actual contract performance, test the feasibility of non-template terms and conditions, and follow the appropriate approval process.
  • Establish and maintain productive business relationships with SCAN's contracted network providers, including medical groups, IPAs, hospitals, ancillary, and supplemental providers, ensuring the network composition includes an appropriate distribution of provider specialties.
  • Accountable for assigned provider network performance related to financial, operational, regulatory, quality, and member satisfaction targets.
  • Develop and execute provider-specific performance improvement plans based on needs identified via Provider Dashboard metrics that highlight operational, quality, financial, and compliance-based measures.
  • Utilize contracting knowledge for effective problem resolution and compliance, responsible for timely and professional interaction in response to contract-related inquiries, research, analyze, and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
  • Participate in regularly scheduled Joint Operations Committee meetings (JOCs) to discuss operational issues relative to all parties, including utilization, financial, enrollment, grievances, provider termination/panel closures, continuity of care, marketing campaigns, etc.
  • Responsible for ensuring the day-to-day operations of the provider network are consistent with SCAN standards/expectations.
  • Act as a technical resource on contract-related issues and offer strong leadership internally as well as externally.
  • Participate in interdepartmental meetings and selected committees, substituting for the Senior Director, Regional Network Management as needed.
  • Develop goals and objectives in concert with the Regional Director, Network Management that align with the organization's vision for future growth and network development.
  • Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, participating in professional societies.
  • Contribute to team effort by accomplishing related results as needed.
  • Actively support the achievement of SCAN's Vision and Goals.
Requirements
  • Bachelor's Degree required.
  • Preferred: Graduate degree in business or healthcare strongly preferred.
  • A comparable combination of education/experience and/or training will be considered equivalent to the education listed above.
  • 5+ years managed care contracting experience required.
  • Prior health plan experience required.
  • Knowledge of CMS, DHCS, and other regulatory requirements required.
  • Strong analytic, quantitative, and problem-solving skills required.
  • Strong negotiation, interpersonal, and presentation skills with an ability to appropriately and effectively address diverse audiences required.