Contract Negotiation Expert

3 days ago


Orange, California, United States The Midtown Group Full time
About The Midtown Group

At The Midtown Group, we are committed to delivering high-quality patient care and improving the health outcomes of our communities. We are a dynamic and growing organization that values innovation, collaboration, and excellence.

Job Summary

We are seeking a skilled Contracts Manager to join our team. The successful candidate will be responsible for managing provider network contracts, health networks, professional, ancillary, and facility providers.

The ideal candidate will have a strong background in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts. Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system is also essential.

Key Responsibilities
  • Negotiate and manage provider network contracts, health networks, professional, ancillary, and facility providers as assigned.
  • Maintain and report the status of Letters of Agreement (LOA) dispositions, develop action plans to transition non-contracted providers to full contracts when possible, and collaborate with other staff to monitor and expedite the credentialing/contracting process.
  • Optimize and maintain 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.
  • Manage project plans when implementing network-wide contract initiatives and coordinate with legal, medical management, provider relations, finance, and OneCare sales and marketing to implement new and renewing provider contracts.
  • Monitor performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models, and financial risk sharing through contractual arrangements.
Requirements
  • Bachelor's degree plus 4 years of experience in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts.
  • Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system.
  • Strong analytical, problem-solving, and project management skills.
  • Ability to work independently and exercise sound judgment.
  • Excellent communication and interpersonal skills.
Work Environment

The selected candidate will work in a dynamic and fast-paced environment with a focus on delivering high-quality patient care. The position requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.



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