Director of Provider Relations and Contracting, CA

Director of Provider Relations and Contracting
Job ID: 7086222
Position Title: Director of Provider Relations and Contracting
Sector: Government: State/Regional/Other
Company Name: Regional Government Services
Field of Interest: Health
Job Function: Management/Administrative
Entry Level: No
Location(s): Oxnard, California, 93030, United States

Posted: August 11, 2010
Job Type: Full-Time
Job Duration: Indefinite
Degree Desired: Master's: MPA, MPP, MPM, etc.
Level of Experience: Mid-Career
Required Travel: 0-10%
Salary: $105,000.00 (Yearly Salary)
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Apply URL: http://www.calopps.org

Job Description

Position: Director of Provider Relations and Contracting for the Ventura County Organized Health Care System

Location: Oxnard, CA

Salary: Up to $105,000 annually (depending upon qualifications)

Apply by: September 1, 2010

Working for Regional Government Services, assigned to the Ventura County Organized Health Care System with administrative offices in Oxnard, California, the incumbent is responsible for the day-to-day leadership of the Provider Relations staff and the creation of a strategic provider enrollment plan; establish and maintain a high quality, cost effective provider network that supports strategic and operational goals; foster and maintain a strong external presence within the provider community while promoting programs and services; coordinate, negotiate, and handle provider contracting relations and services function, including negotiating hospital and tertiary care facilities, long term care, physician (Primary and Specialty Care), and ancillary service agreements; oversees customer service for providers in accordance with health plan, state, and federal regulations and guidelines; formulate and administer organizational policies and procedures.

Principal Functions and Accountabilities

Stewardship & Fiduciary Responsibilities: Monitor provider contracting and relations to determine efficiency and ensure integrity in records, information, and systems in compliance with policies and standards, and state and federal government laws and regulations; negotiate contracts with providers utilizing model provider agreements; follow up on contracts; lead assigned negotiations ensuring the negotiations result in the unit cost targets expected, meet the organization’s objectives, and approximate the State’s reimbursement to the provider; ensure compliance with national contracting standards, including the baseline assessment of risk contracts, reimbursement standards, provider set-up rules, exception process, and model contract language.

Planning: Develop and implement a provider network; identify and initiate contact with potential providers; effectively integrate new programs and strategies and provide oversight to the provider set-up and computer system contract configuration to ensure accurate claims adjudication; participate in multi-disciplinary teams to address unit cost drivers; perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives; plan for continuous upgrading of staff skills.

Project Management: Manage projects well.

Budget/Financial Management: Manage budget and all resources to balance both short and long-term needs.

Reporting: Prepare and analyze reports and records on provider contracting, provider servicing, departmental, and organizational; recommend improvements; evaluate and monitor providers’ performance standards and contract financial performance; disseminate relevant information for effective decision support; monitor and report on action plan achievements.

Key deliverables:

1. Provide leadership and mentoring to staff, positioning staff for success.
2. Develop and maintain strong provider partnership with network to advance the programs and services.
3. Create, measure, and continuously improve highly efficient and effective provider relations function.
4. Continuously increase provider satisfaction levels and decrease provider grievances, provider complaints, and provider dis-enrollment.
5. Ensure the timely resolution of complex provider issues, i.e., improve claims resolution process.
6. Ensure provider communication materials, including directories, newsletters, manuals are efficient and effective and communicated for the most beneficial impact.
7. Develop, communicate, and measure efficient and effective provider and departmental policies and procedures.
8. Identify and resolve internal operational issues or problems and develop internal processes to support these efforts.
9. Establish, coordinate, and create an effective process to disseminate meaningful, actionable, and aligned standard, customized, and ad hoc provider reports.
10. Oversee, coordinate, and measure effective provider orientation programs.
11. Own and manage department budget, ensuring adherence to budget and effectiveness of department.

Additional duties:

1. Represent the plan at applicable external activities, meetings, organizations, conventions, etc.
2. Support department activities as well as others.
3. Lead interdisciplinary activities relating to provider relations across internal and external boundaries.
4. Maintain professional growth and development through self directed learning activities and involvement in professional, civic, and community organizations.

To Apply:

To apply, or find out more detailed information about the job such as job duties, benefits, etc., go to www.calopps.org, select Member Agencies, then choose “Local Government Agencies/Regional Government Services,” where you will see the position listed.

You must submit an online application with cover letter and resume by 5 p.m. on September 1, 2010 at www.calopps.org to be considered. Cover letter should outline your experience and education. Do not submit cover letter/resume directly through email. Emails containing resume and cover letter will not be reviewed. Only formal electronic applications submitted through Calopps will be reviewed. You will have an opportunity to attach a cover letter and resume to your Calopps application online.
Job Requirements

The ideal candidate will have:

Education: Equivalent to bachelor’s degree from an accredited college or university in an appropriate discipline, such as business administration, health care administration, or related field with master’s degree preferred.

Experience: Completion of five years of experience in managing, negotiating, and organizing provider service agreements, and customer service centers with a proven track record of successful negotiation of provider contracts to include the development of language in support of the principles of managed care and Medicaid program regulations.

Knowledge of: people and project management, claims processing, medical economics, finance, and customer service in a managed care or insurance environment.

Skill in: negotiating, consulting, and influencing others; planning and organizing; developing, enhancing, and maintaining interpersonal and professional relationships; being detail oriented, having a high level of accuracy, and follow through; making decisions timely; verbal, written, and non-verbal communication skills; team building; being a key player within the management structure.

Able to: lead and advise on complex issues; listen, resolve, and/or clarify problems; identify, clarify, and address performance expectations; develop employees by providing appropriate and timely feedback and logical career progression/succession planning; recognize priority issues, make quick responses and execute plans; problem-solving; analyze and perform mathematical calculations; exercise tact and diplomacy; interact with a wide variety of others, such as employees, the public, vendors, etc.; thrive in fast paced environment.

Proficiency in: Microsoft Office products.
APPLY FOR THIS JOB
Apply URL: http://www.calopps.org