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Insurance & Claims

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As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Provider Contract Manager- Open to Rancho Cucamonga or Burbank

Location: Rancho Cucamonga, CA Job Number: 724247 Date posted: 08/10/2018
Description: Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring - monitoring - and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cost and competitive data for the development of contracting strategies.


Essential Responsibilities:
  • Contract Negotiation: Negotiates financially competitive and predictable contracts. This includes participating in collaboration with Actuarial Services and internal advisors when appropriate. Evaluates multiple suppliers through a pre-screening process to evaluate a suppliers' opportunity to provide the best quality, price and service, including reviews of supplier dependability and financial solvency. As a result of the pre-screening process, may eliminate potential suppliers from consideration and further contract negotiations.

  • As part of contract negotiations, determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.

  • Prepares a business profile for each potential supplier. The profile indicates the solvency and credit-worthiness of the supplier and to check for any potential problems in the supply chain. This profile is to include: A favorable review of the List Validation and reporting (LVAR) report. A favorable Dunn & Bradstreet Report. Evidence of a robust Quality Program. A review of the Professional Liability & General Liability and Property Damage Insurance minimum limits of $1 million per occurrence, $3 million aggregate (or state regulated limits). Current Licensure, Accreditation and/or Certification.
  • Servicing Regional Stake Holders: Responsible for communications, assessments, identifying network needs, strategy development, financial, implementation, forecasting, etc. May take responsibility, on a periodic basis, for facilitating and direction setting for stake holder meetings and communications. Evaluates regional stake holder business needs, and selects, from multiple approaches, the appropriate consultative approach to ensure successful interactions and outcomes. Responsible for employing account management and customer relationship concepts and techniques to ensure service excellence.

  • Collaboration & Coordination with Provider Relations: This includes provider implementation, communications (provider manual, community provider portal, etc.) maintenance of provider contract files (paper & web), provider data base, provider training, and system configuration quality control.

  • Network Monitoring: Responsible for generating or coordinating the development of metrics, including financial analysis, supplier oversight, network adequacy (accessibility & capacity), member satisfaction, supplier integrity, business continuity, product recall, etc. May be responsible for providing input into determining appropriate next steps. Oversees development of suppliers' corrective action plans and ensures submitted plans meet quality and business process standards. Accountable for ensuring suppliers/suppliers are responsive to quality and service level concerns and influencing stakeholders to ensure that interventions are timely and effective.

  • Regulatory Compliance: Ensures regulatory and statutory compliance of provider contracts and executes on remediation efforts as determined by senior contract managers and leadership. Accountable for ensuring supplier/suppliers are educated on and adhering to the KP Supplier Integrity program. Responds to audit requests for both internal and external audits and develops corrective actions plans, as appropriate.



  • Basic Qualifications:
    Experience
  • Minimum five (5) years of minimum relevant experience.
  • Minimum three (3) years of managed care provider contracting or provider relations experience.
    Education
  • Bachelors degree, OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • MS Word, Excel, Access, Visio & PowerPoint.
  • Thorough knowledge of provider contracting policies, practices and systems.
  • Complete understanding and broad application of principles, theories, concepts, practices, and standards in contract negotiation strategies and techniques.
  • Full knowledge of health care industry content practices.
  • Must be able to work in a Labor/Management Partnership environment.

    Preferred Qualifications:
  • Minimum five (5) years of managed care provider contracting, or provider relations management experience preferred.
  • Minimum two (2) years of health plan operations cross-functional experience (i.e., claims, customer service, quality & utilization management) preferred.
  • Master's degree preferred.

    Primary Location: California,Rancho Cucamonga,Empire Corporate Plaza 10740 4th St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Insurance / Claims Department: National Provider Contracting Travel: Yes, 10 % of the Time
    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.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About Insurance & Claims Careers

    Careers in Insurance & Claims

    Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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