Kaiser Permanente Northwest
Managed Care Contract Manager V **Must be based in the NW Region
Kaiser Permanente Northwest, Portland, Oregon, United States, 97204
Managed Care Contract Manager V **Must be based in the NW Region
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Job Summary In addition to the responsibilities listed below, this position is also responsible for drafting and/or consulting with the legal team on complex contract templates and language; responding to inquiries about complex contract templates and language; researching, comparing, and advising on contract rates and services; developing rate methodology and strategies; collaborating with various services lines to implement rate/contract strategies to improve access and availability and service delivery expansion; interpreting and translating contract terms for senior stakeholders; acting as a role model for the negotiation and completion of companion agreements, letters of intent, and/or memoranda of understanding; and monitoring provider programs in Pay for Performance Agreements, Pay for Quality Agreements, Value Based Purchasing Contracts, and Total Cost of Care.
Essential Responsibilities
Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross‑functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members.
Conducts or oversees business‑specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high‑priority issues or risks, as appropriate; monitors progress and results.
Supports continuous improvement efforts by leveraging innovative and data‑driven approaches to identify and/or consult on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); driving the implementation of process improvement initiatives to aid providers and business goals; collaborating with internal and external partners to develop network strategies and implement improved access to care.
Ensures contract commitments are met by validating, maintaining, and/or conducting statistical analyses on provider and contract data of the day‑to‑day operation and management of services to identify trends and consult on provider compliance; documenting and reporting provider activities and/or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions.
Supports contract strategy development by developing, proposing, and implementing short‑term strategies that improve access to patient care while managing outside service costs; providing in‑depth and advanced consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies.
Grows the Provider Network by reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings using advanced knowledge of current service gaps; developing, maintaining, and managing trusted partnerships with providers to understand their unique service request needs and challenges.; serving as a liaison between providers and KP by coordinating communication efforts (e.g., contract compliance such as access, availability, referral operations, or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings.
Contributes to provider satisfaction by leveraging specialized knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, directories, and other operational issues; leveraging innovative solutions to ensure requests for information, questions, and problems are efficiently identified, documented, and addressed; and in some instances, collaborating on and acting as a role model in the creation and delivery of complex training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.
Minimum Qualifications
Minimum three (3) years of experience in a leadership role with or without direct reports.
Bachelor’s degree from an accredited college or university AND minimum seven (7) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field OR minimum ten (10) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.
Additional Requirements
Knowledge, Skills, and Abilities (KSAs): Contract Management; Contract Law; Business Acumen; Business Process Improvement; Written Communication; Compliance Management; Applied Data Analysis; Trend Analysis; Knowledge Management; Business Relationship Management; Consulting; Interpersonal Skills; Key Performance Indicators; Project Management; Time Management; Quality Assurance Process; Computer Literacy; Presentation Skills; Health Care Reimbursement; Training; Business Planning.
Preferred Qualifications
Four (4) years of experience with health care regulatory compliance and filing, contract writing, health care operations, legal research, or insurance/health plan governance experience.
Project Management Professional (PMP) or equivalent project/program management certification.
Seniority level Mid‑Senior level
Employment type Contract
Job function Management and Manufacturing
Industries Hospitals and Health Care
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Job Summary In addition to the responsibilities listed below, this position is also responsible for drafting and/or consulting with the legal team on complex contract templates and language; responding to inquiries about complex contract templates and language; researching, comparing, and advising on contract rates and services; developing rate methodology and strategies; collaborating with various services lines to implement rate/contract strategies to improve access and availability and service delivery expansion; interpreting and translating contract terms for senior stakeholders; acting as a role model for the negotiation and completion of companion agreements, letters of intent, and/or memoranda of understanding; and monitoring provider programs in Pay for Performance Agreements, Pay for Quality Agreements, Value Based Purchasing Contracts, and Total Cost of Care.
Essential Responsibilities
Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross‑functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members.
Conducts or oversees business‑specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high‑priority issues or risks, as appropriate; monitors progress and results.
Supports continuous improvement efforts by leveraging innovative and data‑driven approaches to identify and/or consult on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); driving the implementation of process improvement initiatives to aid providers and business goals; collaborating with internal and external partners to develop network strategies and implement improved access to care.
Ensures contract commitments are met by validating, maintaining, and/or conducting statistical analyses on provider and contract data of the day‑to‑day operation and management of services to identify trends and consult on provider compliance; documenting and reporting provider activities and/or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions.
Supports contract strategy development by developing, proposing, and implementing short‑term strategies that improve access to patient care while managing outside service costs; providing in‑depth and advanced consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies.
Grows the Provider Network by reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings using advanced knowledge of current service gaps; developing, maintaining, and managing trusted partnerships with providers to understand their unique service request needs and challenges.; serving as a liaison between providers and KP by coordinating communication efforts (e.g., contract compliance such as access, availability, referral operations, or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings.
Contributes to provider satisfaction by leveraging specialized knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, directories, and other operational issues; leveraging innovative solutions to ensure requests for information, questions, and problems are efficiently identified, documented, and addressed; and in some instances, collaborating on and acting as a role model in the creation and delivery of complex training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.
Minimum Qualifications
Minimum three (3) years of experience in a leadership role with or without direct reports.
Bachelor’s degree from an accredited college or university AND minimum seven (7) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field OR minimum ten (10) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.
Additional Requirements
Knowledge, Skills, and Abilities (KSAs): Contract Management; Contract Law; Business Acumen; Business Process Improvement; Written Communication; Compliance Management; Applied Data Analysis; Trend Analysis; Knowledge Management; Business Relationship Management; Consulting; Interpersonal Skills; Key Performance Indicators; Project Management; Time Management; Quality Assurance Process; Computer Literacy; Presentation Skills; Health Care Reimbursement; Training; Business Planning.
Preferred Qualifications
Four (4) years of experience with health care regulatory compliance and filing, contract writing, health care operations, legal research, or insurance/health plan governance experience.
Project Management Professional (PMP) or equivalent project/program management certification.
Seniority level Mid‑Senior level
Employment type Contract
Job function Management and Manufacturing
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Kaiser Permanente Northwest by 2x
Sign in to set job alerts for “Contract Manager” roles. Portland, Oregon Metropolitan Area 3 weeks ago
#J-18808-Ljbffr