Contracts Manager - #689723

CalOptima


Date: 4 days ago

City: Orange, California

Contract type: Full Time

Work schedule: Full Day

Contracts Manager



Job Description


Department(s): Contracting


Reports to: Manager, Contracting


FLSA status: Non-Exempt


Salary Grade: M - 85,000 - 133,100




About CalOptima Health



CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!




About the Position



The Contracts Manager will be responsible for the negotiation and implementation of new and/or renewed provider contracts. The incumbent will be responsible for managing and monitoring contractual relationships with existing CalOptima Health network providers, hospitals, ancillary and other complex provider contracts as assigned per the Board of Directors and executive approval and authority






Duties & Responsibilities:



  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.

  • Negotiates and manages Medi-Cal, Medicare and Medi-Medi provider contracts with physicians, physician groups, hospitals and ancillary providers in conjunction with the Manager or Director of Contracting, as assigned.

  • Builds project plans using appropriate software to manage complex tasks.

  • Manages providers inquiries and coordinates with other departments to resolve provider requests.

  • Coordinates with legal to prepare and update contracts, and related materials as necessary.

  • Communicates with internal and external customers to help facilitate contracting efforts and on-going relationships with provider community to service CalOptima Health members.

  • Monitors the health care marketplace and internal utilization trends to assess new opportunities for cost savings, alternate delivery models and financial risk sharing through contractual arrangements in conjunction with executives.

  • Develops internal processes to monitor performance of assigned networks and recommends strategies to enhance existing networks as identified.

  • Works with executives and other leadership to identify and problem-solve provider contracting issues.

  • Assists with developing desktop procedures, documents network nuances and improves current processes and workflows.

  • Completes other projects and duties as assigned.







Experience & Education:



  • Bachelor's degree in Business Administration, Public Policy, Health Care Administration or related field required.

  • 5 years of managed care contracting, for Medi-Cal, Medicare, and commercial lines of business with a health plan or large provider delivery system required.

  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.









Preferred Qualifications:



3 years of contracting and/or network management experience in California




About our Benefits & Wellness options:



At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options




CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.




If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.




About our Benefits & Wellness options:



At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options




CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.




If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.




About our Benefits & Wellness options:



At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options




CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.




If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.







Job Location: Orange, California


Position Type:




To apply, visit
https://jobs.silkroad.com/CalOptima/Careers/jobs/4168



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