Director, Provider Contracting

This is a fully remote position, open to applicants in California.

📋 Description

• Cultivate, sustain, and grow strategic partnerships across various regions with hospitals, physicians, and ancillary and behavioral health providers.

• Oversee, negotiate, and implement contracts with diverse provider types, alongside the execution of those contracts.

• Identify, create, and execute corporate contracting strategies and business ventures.

• Build and maintain robust working relationships with key hospitals and network providers.

• Manage intricate contracting and negotiations for fee-for-service and value-based reimbursements.

• Conduct independent analyses and collaborate with the Finance Division to assess financial performance and healthcare costs of provider contracts.

• Lead the implementation of complex contracts and proactively identify and address issues related to contracts.

• Develop and oversee value-based contracting incentives and reimbursement methods that prioritize quality and performance.

• Take the lead in resolving advanced and complex contractual issues with both internal and external stakeholders.

• Engage in external provider gatherings and internal operational meetings to enhance relationships, processes, operations, and best practices.

• Supervise the creation of precise and timely internal communications regarding new and renewed managed care agreements.

• Develop, assess, and interpret contract language terms to ensure alignment with company policies and relevant regulatory bodies.

• Oversee all revisions of contract templates, collaborating with Compliance and Legal to ensure templates remain current.

• Create and manage all departmental and organizational resource materials pertinent to Provider Contracting.

• Responsible for training the contracting team on operational updates, departmental changes, and forthcoming projects.

⛳️ Requirements

• Bachelor's degree from an accredited four-year university or equivalent coursework or experience in a managed healthcare-related field.

• Over 10 years of professional experience in managed healthcare administration.

• More than 5 years of experience in people management in healthcare or contracting-related roles.

• Experience in an IPA or managed care environment.

• Strong financial expertise with a capability to analyze and interpret financial trends.

• Demonstrated skills in contract preparation, with extensive knowledge of Medicare, Medi-Cal, PPO, HMO commercial lines of business, various reimbursement methodologies, and value-based contracting.

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage.

• 401k savings plan with a company matching contribution.

• Flexible time off policies along with 9 paid holidays.

• Annual bonus program.