Network Contracting Manager

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aspx The Company: AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population.
We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers.
Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all.
This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment.
As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
The Culture: AlohaCare employees share a passion for helping Hawaii’s most underserved communities.
This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs.
AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees.
Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings.
AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Opportunity: The Network Contracting Manager has two primary responsibilities of Provider Network Development as follows: (1) Planning and implementing the organization’s strategy for provider network development to assure statewide access to care for all covered benefits in a cost effective manner.
(2) Managing and maintaining the contracting process and the contract related activities with the organization’s prospective and existing contracted providers.
Primary Duties and Responsibilities of the Network Contracting Manager : Lead planning and implementation of provider network development and recruitment based on the organization’s network needs statewide.
Develop and execute provider contracting strategies through leadership recommendations, provider proposals, comprehensive analysis, and direct negotiations of contract and compensation terms.
Take primary responsibility for negotiation of all provider contracts that are customized for key provisions and/or compensation terms including hospitals, large provider groups and umbrella entities (ACO/IPA/IDN).
Partner with Provider Operations leadership, Chief Financial Officer and Quality to incorporate value-based purchasing strategies (VBP) into contract templates and negotiations so as to move provider organizations further along the HCP-LAN scale.
Work in partnership, collaboratively with Compliance, Legal counsel, Chief Financial Officer, and other departmental leaders to ensure appropriate use of provider contract templates and rate structures.
Responsible for the development, management and maintenance of the contracting process from negotiation to contract execution, including tracking and management of the provider contracts life cycle including all amendments, addendums, exhibits, and other changes necessitated by operational and/or changes in applicable laws, and communicating updates internally and externally including the storage and retention of contract documents per AlohaCare’s guidelines.
Supervises unit staff.
Coach, train and develop staff to achieve unit goals.
Develops/oversees department performance standards, goals, priorities and budgets.
Responsible for communicating with other departments about network contracting related issues that may impact the organization and takes appropriate action to incorporate changes into the day-to-day operations of the unit.
Responsible for the submission and tracking of BSS system tickets to update system reimbursements as directed by CMS and MQD notices.
Responsible for coordinating with Provider Relations staff to support local provider recruitment, retention, education and contracting using standard templates and fee schedules.
In collaboration with Provider Relations staff, maintain relationships with contracting staff and CFOs at facilities, large provider groups and umbrella organizations as necessary to monitor the performance of and satisfaction with current contracts.
May represent AlohaCare at external provider related events, participate in industry work groups and/or conduct presentations to providers as needed.
Facilitate inter-departmental collaboration for projects, process improvement and on-going operations.
Contribute to the development of provider communications, including surveys, directories, manuals, website and newsletters.
Support department participation in organizational efforts such as open enrollment, quality initiatives, NCQA accreditation, MQD readiness, HSAG audits and other activities.
Monitor organizational compliance with HSAG, MQD, CMS and NCQA network access to care standards and take action to remediate any deficiencies.
Assist with managing of production reports to fulfill contractual, regulatory and accreditation requirements.
Communicate will all internal and external stakeholders with diplomacy, professionalism and knowledge.
Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.
Employees have access to AlohaCare data based on the data classification assigned to this job title.
Requirements of the Network Contracting Manager: Bachelor’s degree Minimum five years’ relevant work experience in a health plan setting, physician group setting or hospital setting (equivalent combination of education and experience will be considered).
Must be able to work independently and employ strong time management and organizational skills Strong interpersonal communication skills, including strong written and oral communication skills Proven track record with provider contract negotiation Working knowledge of Medicaid and Medicare including fee schedules and billing procedures Ability to problem solve, analyze, think critically, exercise sound judgment and make fair decisions.
Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
Demonstrated supervisory/leadership skills, including managing remote team members.
Advanced skills using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
Requires operation of general office equipment to include; PC, fax/copy machine and ACD Mitel Phones.
Valid driver’s license and access to an insured car.
Preferred Requirements of the Network Contracting Manager Public speaking experience Financial analytical skills to discern financial and performance risks Mental, Physical and Environmental Demands: Ability to travel inter-state with occasional overnight stays.
Available to work evenings and some weekends Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.
Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
Inside working conditions No environmental hazards Requires operation of general office equipment to include Network and Computer Salary Range: $85,000 - $100,000 annually AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws.
Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.