Reporting to the Director of Contracting, the Senior Contracts/Network Manager is responsible for analyzing, negotiating, and implementing new HMO, PPO Clinically Integrated Network (CIN), ACO, Professional Provider and Ancillary contract terms.
This position is also responsible for the ongoing management and oversight of sub-capitation agreements, as applicable, to ensure compliance with financial and operational objectives and key contract terms. This position works as a key partner to the Director of Contracting and/or Chief Contracting Officer in negotiating complex and often the most challenging Health Plan, Professional Provider, and Ancillary contract agreements. This position provides subject matter expertise and developmental management coverage/assistance for the Director of Contacting in his/her absence.
Job Responsibilities
- Analyze and recommend rates and terms for HMO, PPO Clinically Integrated network (CIN), ACO, Ancillary and Professional Provider contract terms and take point in their negotiation.
- Act as liaison between Hill Physicians’ departments and the health plans, to identify problem patterns and improve communication and other processes between Hill and the plans.
- Ensure Health Plan compliance with key contract terms, such as capitation deductions.
- Ensure providers meet key operational and financial objectives, such as the cost-effective delivery of care and compliancy with key contract terms.
- Coordinate the efforts of internal departments to ensure appropriate administration of subcontracted services, and to ensure payments are made in accordance with contract terms.
- Be accountable to the Regional Services Department Manager/Director for ensuring contracts meet the overall requirements of the region.
- Support the Director of Contracting and/or Chief Contracting Officer& in generating reports and performing special projects.
- Identify opportunities for cost savings or improved contract terms throughout the network.
- Work in conjunction with Hill Physicians Population Health and Government Programs departments to monitor compliance with Quality and Performance incentives among the different Health Plan agreements.
Required Experience
- Minimum five (5) years’ experience in managed care, with experience in capitated contract environments.
- Demonstrated experience leading provider and health plan contract negotiations. Must have working knowledge of provider & health plan contract authorization and claims payment protocols.
- Strong, demonstrated financial analysis skills (i.e., manipulation and presentation of modeling).
- Exceptional written and verbal communication skills. Strong desktop application skills including Word, Excel, and database management (Access, SharePoint, Salesforce, etc.) skills.
- Ability to identify and define work process issues and work collaboratively to find solutions.
- Effective at working independently and in partnership with key internal stakeholders. Able to develop constructive and credible relationships with external business partners.
- Must be able to manage multiple projects and deadlines successfully and simultaneously.
Required Education
- Bachelor’s Degree or equivalent experience required.
Salary Range
$135-150K/year DOE
Please note that this position will have an (up to 17%) annual performance bonus earning potential and offers a full suite of benefits including 6.5% 401k matching.
This position is hybrid and will require working onsite two days per week.
At Hill Physicians Medical Group, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
Additional Information
We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and one of the “Healthiest Places to Work in the Bay Area.” We have an award-winning Wellness Program, and our average tenure is ~8 years. Every person who joins Hill Physicians is coming in as a leader and has the very real potential to grow with the company as we grow. We’re all in it for the long haul and are bought-in to the success and future of our organization.
We’re proud to have been (and continue to be) a pillar of the Northern Californian healthcare community for more than 30 years. Our more than 5,000 primary care physicians and specialists provide high-quality care across the San Francisco Bay, Sacramento, and Central Valley areas.
By adapting to both the demands of the industry and the needs of consumers, we’ve remained stable and profitable, and our service area now ranges from the Pacific Ocean to the Sierra Nevada’s. We’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Our culture is guided by core values that promote the health and wellness of our employees and communities (health), commitment (accountability), fiscal responsibility (stewardship), teamwork (collaboration), and our dedication to do the right thing (integrity). 97% of employees feel that supervisors and managers “walk the talk” and demonstrate our core values. Join us!
Hill Physicians is an Equal Opportunity Employer
Job Type: Full-time
Pay: $135,000.00 - $150,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Education:
Experience:
- Contract management: 5 years (Required)
- Managed care: 5 years (Required)
- Contract negotiation: 5 years (Required)
- health plan: 5 years (Required)
Ability to Commute:
- San Ramon, CA 94583 (Required)
Work Location: Hybrid remote in San Ramon, CA 94583