Pinnacle Treatment Centers, Inc.
Director of Contract Management
Pinnacle Treatment Centers, Inc., Los Angeles, California, United States, 90079
We offer competitive salaries, full benefits package, Paid Time Off, and opportunities for professional growth.
Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 35,000 patients daily. Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works. Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment. Responsibilities
Contracting
Develops and maintains strong payer relationships. Serves as primary organizational contact and as a communication link between payers and Pinnacle. Identifies appropriate contracting and re-contracting opportunities, which include but are not limited to: Health Insurance plan offerings such as Commercial, Commercial Exchange, Medicare Advantage Medicaid (Managed Care Organizations) MCOs, Medi-Cal Independent Physician Associations (IPAs) and Primary Medical Groups Works with the Senior Director of Payor Operations and the Finance department to perform business and market analyses to determine viability of contracting and to develop new and renewal rate proposals Leads negotiation of contract terms with payers to maximize reimbursement and long-term value of contract. Works with the Senior Director of Payor Operations and Analysis, the Finance department, Revenue Cycle Management, Quality Assurance, Operations, and legal counsel to review proposed contract language and terms to ensure regulatory compliance with state regulations. Communicates with internal parties to ensure contractual terms, including payer-specific requirements, are understood. Serves as expert on all terms of the payer contract. Contract Performance
Monitors contract performance to ensure compliance with terms. Collaborate with the Senior Director of Payor Operations and Analysis, and the Finance department to assemble relevant data and assess financial and operational aspects of payer performance. Interfaces with the Revenue Cycle team to identify contractual conflicts or changes requiring escalation, communicates issues internally with appropriate parties, and leads review and resolution. Communicates all contract changes internally. Identifies issues and opportunities in contract renewal process. Provides support for assessment of quality-of-care indicators and clinical outcomes. Facilitates ongoing dialog between Pinnacle and payor clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and Readmissions Market
Research, analyze, and reports on the healthcare market and regulatory environment to identify contracting opportunities and risks and maintain awareness of competitor activity. Contract Management
Works with the Senior Director of Payor Operations and Analysis and legal counsel to develop corporate standards for contracts, including payment terms and legal provisions. Ensuring payer contracts are centrally maintained and organized. Other
Provides support for assessment of quality-of-care indicators and clinical outcomes. Facilitates ongoing dialog between Pinnacle and payer clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and readmissions. Other duties as assigned Benefits
18 days PTO (Paid Time Off) 401k with company match Company sponsored ongoing training and certification opportunities. Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance. Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) Discounted tuition and scholarships through Capella University Salary
$120,000 – $140,000 Bonus eligible Requirements
Strong record of success as an emerging leader in a complex, matrixed environment Demonstrated record of accomplishment of building strong working relationships across internal constituents (e.g., market and regional P&L and operational leaders) and external constituents (e.g., private payors such as UHC, BCBS and Humana) Bachelor’s degree, preferably in Business or related Healthcare administration required Minimum of 10 years in progressive roles in payor and/or provider organizations required Demonstrated analytical, project management, and leadership skills Sound understanding of provider revenue cycle, payor enrollment and credentialing, and materially impactful contract language Experience in network management and/or payor contracting Knowledge of value-based contract methodologies and preferred financial and administrative terms Ability to think independently and develop new processes and analyses as required Valid driver’s license in good standing Ability to travel up to 20% as needed including overnight travel Preferred
Master’s degree in business or healthcare administration or additional experience can substitute for an advanced degree Knowledge and understanding of health plan network operations Substance Use Disorder segment experience Join our team. Join our mission. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Pinnacle Treatment Centers is an equal employment opportunity employer and makes employment decisions based on merit and other legitimate business considerations. We want to have the best available persons in every job. Company policy prohibits unlawful discrimination based on race, traits historically associated with race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), parental leave, national origin, gender, gender identity, gender expression, age, ancestry, physical or mental disability, military and veteran status, marital status, sexual orientation, genetic characteristics or information, political affiliation, non-merit based factors or any other consideration made unlawful by applicable federal, state, or local laws. It also prohibits discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.
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Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 35,000 patients daily. Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works. Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment. Responsibilities
Contracting
Develops and maintains strong payer relationships. Serves as primary organizational contact and as a communication link between payers and Pinnacle. Identifies appropriate contracting and re-contracting opportunities, which include but are not limited to: Health Insurance plan offerings such as Commercial, Commercial Exchange, Medicare Advantage Medicaid (Managed Care Organizations) MCOs, Medi-Cal Independent Physician Associations (IPAs) and Primary Medical Groups Works with the Senior Director of Payor Operations and the Finance department to perform business and market analyses to determine viability of contracting and to develop new and renewal rate proposals Leads negotiation of contract terms with payers to maximize reimbursement and long-term value of contract. Works with the Senior Director of Payor Operations and Analysis, the Finance department, Revenue Cycle Management, Quality Assurance, Operations, and legal counsel to review proposed contract language and terms to ensure regulatory compliance with state regulations. Communicates with internal parties to ensure contractual terms, including payer-specific requirements, are understood. Serves as expert on all terms of the payer contract. Contract Performance
Monitors contract performance to ensure compliance with terms. Collaborate with the Senior Director of Payor Operations and Analysis, and the Finance department to assemble relevant data and assess financial and operational aspects of payer performance. Interfaces with the Revenue Cycle team to identify contractual conflicts or changes requiring escalation, communicates issues internally with appropriate parties, and leads review and resolution. Communicates all contract changes internally. Identifies issues and opportunities in contract renewal process. Provides support for assessment of quality-of-care indicators and clinical outcomes. Facilitates ongoing dialog between Pinnacle and payor clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and Readmissions Market
Research, analyze, and reports on the healthcare market and regulatory environment to identify contracting opportunities and risks and maintain awareness of competitor activity. Contract Management
Works with the Senior Director of Payor Operations and Analysis and legal counsel to develop corporate standards for contracts, including payment terms and legal provisions. Ensuring payer contracts are centrally maintained and organized. Other
Provides support for assessment of quality-of-care indicators and clinical outcomes. Facilitates ongoing dialog between Pinnacle and payer clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and readmissions. Other duties as assigned Benefits
18 days PTO (Paid Time Off) 401k with company match Company sponsored ongoing training and certification opportunities. Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance. Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) Discounted tuition and scholarships through Capella University Salary
$120,000 – $140,000 Bonus eligible Requirements
Strong record of success as an emerging leader in a complex, matrixed environment Demonstrated record of accomplishment of building strong working relationships across internal constituents (e.g., market and regional P&L and operational leaders) and external constituents (e.g., private payors such as UHC, BCBS and Humana) Bachelor’s degree, preferably in Business or related Healthcare administration required Minimum of 10 years in progressive roles in payor and/or provider organizations required Demonstrated analytical, project management, and leadership skills Sound understanding of provider revenue cycle, payor enrollment and credentialing, and materially impactful contract language Experience in network management and/or payor contracting Knowledge of value-based contract methodologies and preferred financial and administrative terms Ability to think independently and develop new processes and analyses as required Valid driver’s license in good standing Ability to travel up to 20% as needed including overnight travel Preferred
Master’s degree in business or healthcare administration or additional experience can substitute for an advanced degree Knowledge and understanding of health plan network operations Substance Use Disorder segment experience Join our team. Join our mission. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Pinnacle Treatment Centers is an equal employment opportunity employer and makes employment decisions based on merit and other legitimate business considerations. We want to have the best available persons in every job. Company policy prohibits unlawful discrimination based on race, traits historically associated with race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), parental leave, national origin, gender, gender identity, gender expression, age, ancestry, physical or mental disability, military and veteran status, marital status, sexual orientation, genetic characteristics or information, political affiliation, non-merit based factors or any other consideration made unlawful by applicable federal, state, or local laws. It also prohibits discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.
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