Top Provider Network Executive jobs in Saginaw, MI

LOCATION

301 S Crapo St, Mount Pleasant, MI 48858

SCHEDULE

This is a full time, hybrid position, 40 hours per week. The schedule is generally 8am - 5pm, Monday through Friday however there is flexibility with supervisor approval and this will be further discussed in the interview.

COMPENSATION & BENEFITS

Salary Range: $72,821- $94,931 depending on experience

• Student loan forgiveness through the Public Service Loan Forgiveness Program
• NHSC & MI Kids Now approved facility for student loan repayment program
• Health benefits through BCBS with employer contributions to the HSA
• 12 weeks of 100% paid maternity and paternity leave
• Employer funded short- and long-term disability
• Comprehensive dental and vision benefits
• 100% employer funded Defined Benefit (pension) program with vesting after 6 years
• 30 paid leave days (16 annual/12 sick/2 floating) during first year of employment, this increases with years of service
• Performance-based compensation plan with annual increases
• Professional development opportunities
• Free CEU training opportunities
• 12 paid holidays

SUMMARY

General Description: Oversees activities concerned with the development, procurement, compliance, evaluation and renewal of contracts and is the main contact for the provider network. Coordinates revenue contracts, leases and other administrative services contracts. Acts as Business Associate Head and assures Business Associate compliance with HIPAA and HI TECH Act related regulations. Acts as the Fair Hearing Officer, representing the agency during Medicaid Fair Hearings.

Responsibilities and Duties: Develops standard contract language for all agency contracts on an ongoing basis to assure compliance with agency, state and federal rules and regulations. Develops and maintains model contracts, attachments and requests for proposals (RFPs) according to provider type. Provides consultation and sets standards in the RFP process. Advises Management on contractual obligations. Reviews external contracts from other entities. Oversees procurement process for contracted services including provider recruitment and credentialing, review of bids or renewals, cost estimation, approvals and processing. Manages review of bids or renewals for conformity to contract requirements including requests for deviations from requirements. Determines reasonableness of costs and makes appropriate recommendations. Coordinates preparation of contractual attachments defining service delivery expectations and financial terms. Provides oversight on claims, complaints and sanctions in the performance of contracts and otherwise monitors contract compliance. Coordinates the contract renewal process including obtaining provider performance evaluations from service programs and ensuring contracts are fully executed. Conducts evaluations of contracts as appropriate prior to renewal. Compiles expense and revenue contract information for agency budgeting. Evaluates CMH interagency agreements and other revenue contracts. Works, through contractual provision, to assure Business Associates (vendors, contracted service providers, consultants, external auditors, sub-contractors and regulatory/accreditory agencies) comply with the HIPAA and the HI TECH Act. Defines and conducts provider network system monitoring processes. Communicates and coordinates efforts with other teams and staff. Provides cost analyses for service authorization requests as necessary. Coordinates lease agreements. Develops and maintains policies, procedures and reports as required. Computerizes processes as appropriate. Coordinates privileging and credentialing functions for CMHCM licensed independent practitioners under contract. Leads and coordinates performance improvement and communication efforts with the provider network including provider network meetings, forums and newsletters. Represents the agency during Medicaid fair hearings, preparing hearing summaries and presenting a defense of agency action taken to the state administrative tribunal.

The above statements are intended to describe the general nature and level of work being performed by people assigned this title. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. They are not intended to limit or in any way modify the right of supervisors to assign, direct and control the work of employees under their supervision. The above statements will also incorporate knowledge about and actively support: 1) culturally competent recovery based practices, 2) person-centered planning, and 3) a trauma informed culture of safety to aid consumers in the recovery process as applicable to the work performed.

EMPLOYMENT STANDARDS

General Education:

College: Bachelor's Degree required, Master's Degree preferred. Major: Finance, Accounting or Business Administration.

Courses: Contract Law, Management, Accounting, Psychology, and Computers

Job-Related Experience: 3 years experience in development of contracts and contract management. Experience in healthcare industry helpful. Licenses, etc.: Valid driver's license while operating vehicle on agency business.

CONDITIONS OF EMPLOYMENT

Knowledge: Working knowledge of computers, data systems and reporting. Knowledge of contract law and processes. Knowledge of management principles and contract agencies. Knowledge of finance principles, accounting principles, costing methods and state budgeting process. Knowledge of agency services and goals. Knowledge of Privacy and Security Standards of HIPAA.

Skills: Preparing RFPs, bids and proposals. Preparing or analyzing financial terms or conditions. Analyzing procurement requirements and provider capabilities. Analyzing contract language, laws, etc. Use of computers and calculator. Skilled in transferring information between spreadsheets and databases and developing computer reports for contracts.

Abilities: Ability to coordinate work with other staff, provide leadership, organize projects, provide training and work with staff from outside entities. Ability to evaluate and recommend providers based on availability, reliability and cost to obtain the highest quality service at the lowest price. Ability to monitor contracts, collect and analyze financial data. Ability to manage multiple tasks, organize various processes and plan for change. Ability to demonstrate human relation skills through strong working relationships with other administrative, supervisory and agency staff and contract agencies. Ability to maintain favorable public relations and provide community leadership. Ability to chair provider meetings and forums. Ability to write and speak effectively. Ability to exercise considerable independent and mature judgment. Ability to effectively utilize computers to organize and analyze data.

Physical Demands: Work is sedentary and involves typical office behaviors such as reaching, handling, and fingering. Some travel is necessary. Near acuity and accommodation necessary for checking figures.

Work Environment: Work is performed in a typical office setting.