Managed Care Provider Relations Manager jobs in Salem, OR

Location: Remote: This position has the possibility of being 100% remote.

Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person at YCCO's office in McMinnville, OR.

Department:    Finance                                                        FLSA Status:                Exempt

Reports To:      Contracts Manager                                     Physical Strength:       Light (L)

Learn more about Yamhill Community Care:  click here

Summary

The Provider Contracts Specialist is responsible for assisting with the development and maintenance of a comprehensive health service delivery system and providing high quality and cost-effective service to Yamhill Community Care (YCCO) members. The primary focus is on the retention and growth of a healthy physical health provider network, to include primary care, specialty, and hospital care providers. 

Essential Duties

1. Develops and implements of a contracting system that supports YCCO’s ability to meet contractual and regulatory obligations.
2. Facilitates development and negotiation of contracts, agreements, memorandum of understanding (MOU), grant agreements, and letters of agreement. 
3. Maintains knowledge of federal, state, and national contracting rules and regulations, including those relevant to behavioral health contracts.

Job Duties

• Collaborates in the development and maintenance of a comprehensive health service delivery system which provides high quality and cost-effective service to YCCO members.
• Knowledgeable in the principles of managed care, value-based purchasing, and alternate payment methodology.
• Works with Contracts Manager and Chief Financial Officer (CFO) to expand alternate payment methodology.
• Leads assigned negotiations (i.e., hospital, primary care, and ancillary) and ensures that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate YCCO’s reimbursement to the contracted provider.
• Supports, collaborates with, and backfills contracting responsibilities as needed within the Contracts team.
• Actively follows contracting best practices.
• Ensures integration of work between program functional areas and promotes effective communications within YCCO and between external partners and providers.
• Identifies opportunities for cost savings and process improvements.
• Tracks and ensures accuracy of contracts and amendments.
• Monitors and facilitates response to requests for amendments to contracts and rate increases.
• Drafts and amends YCCO contracts, agreements, memorandum of understanding, and letters of agreement.
• Works with Contracts Manager and designated subject matter experts in evaluating contract language, terms, and requirements.
• Models current and proposed contract terms, using claims data, to calculate the bottom-line impact of those terms.
• Conducts analysis related to provider contract renewals, including market research and competitive analysis.
• Performs studies to monitor and assess changes in provider billing patterns, charge description masters, and other variable reimbursement provisions.
• Collaborates with other departments to address and resolve operational issues.
• Serves as a technical and operational contract subject matter expert.
• Prepares reports, as requested.
• Strategizes with other members of the YCCO team to ensure access and quality of care. 

Essential Department & Organizational Functions

• Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments, including Health Plan Operations and Compliance to assist with audits; including the External Quality Review (EQR), as needed.
• Proposes and implements process improvements.
• Meets deadlines for completion of assigned responsibilities and projects.
• Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
• Demonstrates cooperation and teamwork using a professional and respectful demeanor.
• Provides cross-training on specific job responsibilities.
• Meets identified goals that contribute to departmental goals.
• Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor.
• Performs other duties as assigned.

Knowledge, Skills, & Abilities

• Working knowledge of Oregon Health Plan benefits, Oregon Administrative Rules (OAR), Oregon Statutes, and Community Care Organization requirements.
• Knowledgeable about health system contracting and procurement best practices.
• Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
• Ability to communicate both professionally and effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to remain flexible, positive, and adaptable.
• Ability to work across the YCCO region and to work remotely, as needed. 

Supervisory Responsibilities

This position has no supervisory responsibility.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation(s) may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• Three (3) years of grants, contracts, and/or procurement administration experience.

     OR:

• Any combination of education and experience that would qualify candidate for the position.

Preferred:

• Bachelor’s degree in Finance, Business, Business law, or Economics.
• One (1) year experience in Managed Healthcare and/or Medicaid Provider Contracting experience.

Certificates, Licenses and/or Registrations

This position does not require any certificates, licenses, or registrations. 

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this position. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl. The employee may occasionally need to lift and/or move up to 25 pounds.

This position operates in a professional office environment and requires frequent use of standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Specific vision abilities required by this job include close vision, color vision, distance vision, depth perception, and ability to adjust focus. The noise level in the work environment is usually moderate.

This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.