Provider Contracting Manager jobs in California

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)

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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

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Manager, Provider Contracting
  • Adventist Health
  • Roseville, CA FULL_TIME
  • Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified ca...
  • 4 Days Ago

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Provider Contracting Specialist, Experienced
  • Blue Shield of CA
  • Long Beach, CA FULL_TIME
  • Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contract...
  • Just Posted

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Director, Provider Recruitment and Contracting
  • Community Health System - CA
  • Fresno, CA FULL_TIME
  • Overview: We got our start 125 years ago as a boarding house and medical facility for people traveling in Central California. If people then could see us now... Today, Community Health System is the r...
  • Just Posted

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Director, Provider Recruitment and Contracting
  • Community Medical Centers of Fresno, CA
  • Fresno, CA OTHER
  • Overview We got our start 125 years ago as a boarding house and medical facility for people traveling in Central California. If people then could see us now... Today, Community Health System is the re...
  • 2 Days Ago

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Provider Contracting Professional
  • Humana
  • California, CA FULL_TIME
  • Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, Humana ) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encoura...
  • 27 Days Ago

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Contract Manager - Contracts & Technology Legal
  • The Travelers Indemnity Company
  • New York, NY
  • Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this...
  • 3/28/2024 12:00:00 AM

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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

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Provider Contracts Manager
  • Molina Healthcare
  • Rochester, NY
  • ***Remote and must live in New York*** Job Description Job Summary Molina Health Plan Provider Network Contracting jobs ...
  • 3/25/2024 12:00:00 AM

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Contract Manager
  • CyrusOne
  • The Contract Manager will assist in the management of all third party or outsourced vendors with a specific concentratio...
  • 3/25/2024 12:00:00 AM

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Contract Manager
  • Accede Solutions, Inc.
  • Carbondale, IL
  • Duration: 1 year Mon - Thu Responsibilities: Negotiate contracts with vendors, suppliers, and service providers to ensur...
  • 3/25/2024 12:00:00 AM

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Provider Contracting Manager | Bay Area
  • Selby Jennings
  • Overview Our client, a large health insurance agency, is seeking a skilled Provider Contracting Manager to oversee the n...
  • 3/24/2024 12:00:00 AM

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Contract Manager
  • VieMed
  • Lafayette, LA
  • Essential Duties and Responsibilities Maintain catalog of approved vendors for VieMed. Ensure all stages of the vendor o...
  • 3/24/2024 12:00:00 AM

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Contract Manager
  • MbSolutions, Inc.
  • Fort Belvoir, VA
  • Contract Manager: Education: Minimum of a bachelor's degree. Qualifications: Minimum of eight years of Army Force Manage...
  • 3/24/2024 12:00:00 AM

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$120,158 to $159,569

Provider Contracting Manager in Gastonia, NC
By simplifying and automating the provider contracting lifecycle, we help make it easier for health plans to identify and implement savings opportunities to obtain maximum value from provider relationships.
January 09, 2020
Provider Contracting Manager in Springfield, IL
Responsible for the oversight of their assigned networks to ensure network provider deficiencies are being met and working closely with their assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
January 19, 2020
Provider Contracting Manager in Cedar Rapids, IA
New care delivery models, complex regulations and narrowing provider networks have significantly altered the provider contract management process.
February 03, 2020