Contract Manager - Provider Relations
Primary Location Honolulu, Hawaii
Worker Location Flexible
Job Number 1307090 Date posted 09/12/2024
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Description:
Essential Responsibilities:
Note: Work location is on-site with flexibility and the primary location will be in-office for meetings. Residence required in the primary location state. 711 Kapiolani Blvd., Honolulu, Hawaii 96813
Job Summary:
Identifies outside service needs and opportunities to complement overall supplier relationships and care delivery. Collaborates with service chiefs and others to develop contracting strategies. Develops and maintains relationships with external care providers and suppliers. Works with individual doctors offices. Serves as a resource specialist for contracting and negotiation.
Essential Responsibilities:
- Identifies and/or anticipates outside service needs to complement overall care delivery. Collaborates with appropriate leadership teams in development of contracting strategies and other objectives. Negotiates medical care/service and other contracts for health plan membership and hospitals. Monitors compliance with contract terms and conditions. Negotiates resolution of disputes.
- Develops and maintains relationships with internal/external care providers. Maintains provider relations. Serves as resource specialist in contracting and negotiation.
- Monitors external healthcare delivery marketplace and internal utilization trends. Assesses new opportunities for cost savings, alternative delivery models and financial risk sharing.
- Develops reimbursement methodologies and understands Medicare and Medicaid reimbursement policies and regulations. Develops payment strategies.
- Performs analysis of contracts for impact assessment and recommends changes as appropriate.
- Ensures compliance with related regulatory requirements. Provides counsel to regional leadership and work teams on contracting issues. Provides direction in communicating contract reimbursement terms to the claims department. Provides direction regarding contract implementation.
Basic Qualifications:
Experience
- Minimum four (4) years contracting experience to include medical expense and utilization analysis or JD with one year contracting experience.
Education
- Bachelors degree in business, finance, healthcare administration, or related field OR four (4) years directly related experience.
License, Certification, Registration
- Driver's License (Hawaii)
Additional Requirements:
- Demonstrated knowledge of healthcare/ commercial/business contracting, financial and policy analysis, healthcare delivery and payment systems, and competitive market strategies systems.
- Demonstrated knowledge of Center for Medicaid -Medicaid Services payment methodologies and regulations.
- Demonstrated knowledge of NCQA and TJC accreditation and state and federal regulatory requirements specific to healthcare organizations.
- Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiation, interpersonal relations, oral communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation, and project management.
- Demonstrated knowledge of and skill in word processing, multimedia presentations, spreadsheet, and database PC applications.
Preferred Qualifications:
- Demonstrated knowledge of HMO healthcare delivery systems.
- Contract negotiations experience.
- Demonstrated knowledge of Kaiser Permanente systems and processes.
- Masters degree in business, finance, healthcare administration, or related field or JD.
Primary Location: Hawaii,Honolulu,Regional Admin Low Rise
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri,
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-HI-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Moanalua Medical Center - Admitting Unit - 1201
Pay Range: $70400 - $91080 / year
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
