Provider Contracting Manager jobs in San Jose, CA

Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

S
Provider Contracting Manager
  • Santa Clara Family Health Plan
  • San Jose, CA FULL_TIME
  • Provider Contracting Manager

    Salary Range: $104,280 - $161,634
    The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

    FLSA Status:Exempt
    Department:Provider Network Operations
    Reports To:Director, Provider Network Operations

    GENERAL DESCRIPTION OF POSITION

    The Provider Contracting Manager has accountability for the day-to-day handling of Santa Clara Family Health Plan's provider agreements, including the review and negotiation. The Provider Contracting Manager will apply all state and federal regulations, and Health Plan operational processes to negotiate and implement provider agreements. The Provider Contracting Manager will coordinate the financial analyses of contracts, and actively participate in Contracting Committee meetings, as well as meet and confer with providers, health plans, third party vendors, and other customers.

    ESSENTIAL DUTIES AND RESPONSIBILITIES

    To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

    1. Ability to understand and apply state and federal regulations, and operational requirements. Use independent judgment to apply policies and procedures for continued Health Plan compliance. (R)
    2. Coordinate financial analysis of contracts to ensure financial viability of initial contracts and renewals. Utilize financial analysis to make contracting recommendations, and provide input around reimbursement and contracting strategies. (R)
    3. Handle day-to-day contract negotiations with health plans, Independent Practice Associations (IPAs), independent providers, hospitals, ancillary providers and vendors for all lines of business, and for all covered services. (R)
    4. Understand alternative payment methodologies, such as pay-for-performance and shared savings. Ensure successful implementation and measurement of such methodologies.
    5. Develop gap analyses in coordination with the Provider Network Access Manager and Contracting Coordinators to identify and strategize growth opportunities within the provider network.
    6. Coordinate closely with the compliance team to formulate and implement resources to ensure appropriate oversight and audits of delegated entities.
    7. Build and maintain effective and positive relationships with providers.
    8. Be responsive to organizational requests related to provider contracting, including needs related to out of network requests in order to ensure members have appropriate access to care.
    9. Communicate clearly and effectively, and collaborate across the organization to achieve organizational goals and objectives.
    10. Perform other related duties as required or assigned.
    REQUIREMENTS - Required (R) Desired (D)

    The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

    1. Bachelor's Degree in Healthcare Administration, Business, or a related field. (R)
    2. Master's Degree in Healthcare Administration, Business, or a related field. (D)
    3. Minimum four years of experience in managed care or in a healthcare setting in positions requiring routine interaction with internal and external stakeholders, two years of which involved direct experience in provider network contracting activities. (R)
    4. Working knowledge of various contracting methodologies for Medi-Cal and Medicare, including fee for service arrangements, capitated agreements and alternative payment methodologies.
    5. Ability to understand and stay current on contracting guidelines, regulations, and resources, and apply requirements to related tasks, audits, tools, and methodologies. (R)
    6. Ability to exercise discretion and make decisions to identify and pursue providers and negotiate reimbursement arrangements. (R)
    7. Strong oral and written communication and negotiation skills. (R)
    8. Ability to research, analyze, and interpret managed care benefits, laws, and regulations for the purpose of policy creation and application, either internally or when conducting oversight audits. (R)
    9. Proficient in adapting to changing situations and efficiently alternating focus to support department operations as dictated by business needs. (R)
    10. Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
    11. Working knowledge and the ability to efficiently operate all applicable computer software including applications such as Outlook, Word, PowerPoint and Excel. (R)
    12. Ability to use a keyboard of moderate speed and high level of accuracy. (R)
    13. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R)
    14. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
    15. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
    16. Ability to maintain confidentiality. (R)
    17. Ability to comply with all SCFHP policies and procedures. (R)
    18. Ability to perform the job safely with respect to others, to property and to individual safety (R)
    PHYSICAL REQUIREMENTS

    Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

    1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
    2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
    3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
    4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
    5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
    6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
    ENVIRONMENTAL CONDITIONS

    General office conditions. May be exposed to moderate noise levels.

    EOE

     

  • 19 Days Ago

A
Cleaner
  • Aware Manager
  • San Jose, CA CONTRACTOR
  • Cleaner We are looking for a Cleaner to take care of our facilities and carry out cleaning and maintenance duties. The goal is to keep our building in a clean and orderly condition. Responsibilities C...
  • 5 Days Ago

G
RWSHR - Group Sales Manager
  • Group Sales Manager
  • Menlo, CA FULL_TIME
  • KEY RESPONSIBILITIESJob SummaryTarget, solicit and cultivate business within the group market segment, with efforts directed towards room night revenue generation, as well as securing group affiliated...
  • 13 Days Ago

K
Urgent Care NP/PA
  • KPG Provider Services, LLC
  • San Jose, CA FULL_TIME
  • Outpatient Facility: Looking for an experienced Urgent Care NP/PA in the San Jose, California area. Below you will find the Position Overview with all the detail regarding the position. Position Overv...
  • 23 Days Ago

Q
Board Certified Behavioral Analyst - Master Trainer
  • QBS, provider of Safety-Care
  • San Jose, CA FULL_TIME
  • Safety-Care Master Trainer (BCBA)***Must be able to travel 60% or more overnight in any given workweek, 2-3 weeks a month.***Must be a Board-Certified Behavior Analyst (BCBA)***Must live within 60 min...
  • 1 Month Ago

G
Store Manager
  • Garage clothing-Store Manager-Stoneridge Mall
  • Pleasanton, CA FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 23 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Provider Contracting Manager jobs found in San Jose, CA area

M
CDMA Clinical Contract Manager - Remote
  • Maxis Clinical Sciences
  • Pleasanton, CA
  • Job Description Job Description The Clinical Contracts Specialist Sr (position title may be Clinical Contracts Manager) ...
  • 3/28/2024 12:00:00 AM

B
Indirect Procurement Director
  • Barracuda Networks Inc.
  • San Jose, CA
  • Job ID 24-368 Come Join Our Passionate Team! At Barracuda, we make the world a safer place. We believe every business de...
  • 3/28/2024 12:00:00 AM

C
Contracts Manager / Senior Contracts Manager
  • Cymabay Therapeutics
  • Newark, CA
  • We are searching for a Contracts Manager / Senior Contracts Manager to join our legal department. The candidate will nee...
  • 3/27/2024 12:00:00 AM

V
Manager, Contract Strategy and Operations
  • Verkada
  • San Mateo, CA
  • Who We Are Verkada is the largest cloud-based B2B physical security platform company in the world. Only Verkada offers s...
  • 3/27/2024 12:00:00 AM

B
Contracts Manager I
  • Box
  • Redwood City, CA
  • WHAT IS BOX?Box is the market leader for Cloud Content Management. Our mission is to power how the world works together....
  • 3/25/2024 12:00:00 AM

R
Senior Property Manager - Regional Portfolio Manager
  • Rent Real Homes Ca
  • Sunnyvale, CA
  • Job Description Job Description We are looking for an energetic Senior Property manager/Regional Manager to help run the...
  • 3/25/2024 12:00:00 AM

A
CDMA Clinical Contract Manager
  • Apollo Professional Solutions
  • Pleasanton, CA
  • Job Description DISTINGUISHING CHARACTERISTICS: This is a job requiring a combination of advanced skills and experience ...
  • 3/24/2024 12:00:00 AM

V
Sourcing Operations, Analytics and Contracts Manager, Commercial Manufacturing & Supply Chain
  • Vaxcyte
  • San Carlos, CA
  • Company Profile: Vaxcyte, Inc. (Nasdaq: PCVX) is a vaccine innovation company engineering high-fidelity vaccines to prot...
  • 3/24/2024 12:00:00 AM

San Jose is located at 37°20′07″N 121°53′31″W / 37.335278°N 121.891944°W / 37.335278; -121.891944. According to the United States Census Bureau, the city has a total area of 180.0 sq mi (466 km2), of which 3.4 sq mi (8.8 km2) (1.91%) is water, making it the fourth-largest California city by land area (after Los Angeles, San Diego and California City). San Jose lies between the San Andreas Fault, the source of the 1989 Loma Prieta earthquake, and the Calaveras Fault. San Jose is shaken by moderate earthquakes on average one or two times a year. These quakes originate just east of the city on...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$136,716 to $181,559
San Jose, California area prices
were up 2.9% from a year ago

Provider Contracting Manager in Scranton, PA
In order to properly oversee provider contracts, insurance companies must ensure all the medical professionals they are contracting with are properly credentialed; maintain detailed price sheets to standardize how much they are paying for services; and keep historical records of each account.
December 11, 2019
Provider Contracting Manager in Allentown, PA
The complete report provides the full listing of all companies nominated, as well as benchmark ratings for a listing of 40+ companies in account support and contracting.
January 16, 2020
Provider Contracting Manager in Savannah, GA
The Senior Provider Contract Manager is responsible for developing, negotiating, managing and leading complex contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost-effective providers of healthcare services.
January 03, 2020