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Director of Contracting 69662

Medical/HealthPosted 19 days 7 hours 14 minutes ago. Viewed: 34 times.

Description

DIRECTOR of CONTRACTING

Perform duties to coordinate and negotiate hospital physician school and ancillary service agreements that are in accordance with Corporate health plan and State guidelines.

POSITION QUALIFICATION REQUIREMENTS: Knowledge Experience: Equivalent to a bachelor’s degree in a related field master’s degree preferred plus 5-7 years related experience including 3 years of management experience; experience in a managed care or insurance environment preferably in Medicaid; knowledge of related field. Thorough skills and knowledge of contracting sales provider customer service and or marketing. Knowledge of contracting language and the principles of negotiation. Experience in claims processing marketing sales medical economics health plan finance and or customer service experience in a healthcare or insurance environment. Experience in managed care State and or Federal health programs and project management.

PRINCIPAL FUNCTIONS & ACCOUNTABILITIES: Significant Duties: Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers. Negotiate contracts with interested providers utilizing model provider agreements and follow up on contracts as appropriate. Leads assigned negotiations i.e. hospital physician and ancillary and ensure that the negotiations result in the unit cost targets expected and meet the objectives of the Company and approximate the State’s reimbursement to the provider. Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. Evaluate and monitor providers’ performance standards and financial performance of contracts. Facilitate the organization of provider focus groups. Ensures compliance with national contracting standards including for example the baseline assessment of risk contracts e.g. Model 1 Model 1 Lite etc. reimbursement standards provider set-up rules exception process and use of model contract language. Participates in multi-disciplinary team activities to address unit cost drivers. Implement strategies to reach pmpm targets. Performs basic financial analyses to identify medical cost improvement opportunities and develops and executes contracting action plans to achieve results.


Industry: Misc. Healthcare
Discipline: Healthcare Admin
Experience: 5 - 7 Years
Level: Director
Compensation: Up to $115K
Company: Physician Owned Practice

Contact information

Apply Online at TheLadders.com