Oregon Medical Group Management Association

Provider Contract Manager 2 - Full Time

12/29/2021 10:03 AM | Mindy Zaubi (Administrator)

posted 12.29.2021

Provider Contract Manager 2

Location: Portland, Oregon

How to apply: Visit our careers website at www.nwpermanente.com or contact Andi Price and email resume to andrea.m.price@kp.org.

Click here to download and review the full Job Description, Experience and Qualifications.

The overall purpose of the Provider Contract Manager 2 position is to effectively manage an assigned portfolio of NWP, KFH and KFHPNW contracted provider relationships in a manner consistent with (1) NWP’s objectives, (2) KFH and KFHPNW’s objectives, (3) NCQA, JCAHO, and other accreditation requirements, (4) applicable federal and state laws and regulatory requirements, (5) meets the Care Delivery needs of KFHP-NW’s Members, and (6) upholds the business, finance, regulatory and reputational interests of KPNW.

 Join our medical group

Northwest Permanente is a self-governed (physician-led), multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.

 Major Responsibilities

 Contract Negotiation and Network Development: 

  • Identifies and/or anticipates outside medical care service needs and opportunities to complement Region’s overall care delivery. Collaborates with Finance and Operations leaders, Senior Department Administrators, Department Administrators, Service Chiefs, Sr. Director and Director of Provider Contracting and Associate Medical Director of Business Affairs to develop contracting strategies.
  • Develops and maintains relationships with internal and external care providers. Participates in community relations activities to enhance the image and reputation of the organization.
  • Successfully negotiate contracts that achieve cost reduction or other contract and relationship maximization. This includes facilities, individual and group medical practices, using a diverse range of techniques and contracting ''best practices'', to include DRG’s, per diems, case rates, and other industry standard payment methodologies.
  • Negotiate key financial and operational terms with hospitals, physicians and ancillary providers in a manner consistent with market strategy utilizing approved contract templates, approved reimbursement methodologies, KP clinical needs and standards, and applicable laws and regulations. Ensure negotiated terms are accurately and thoroughly documented in contractual agreements in order to mitigate financial or legal risk to the organization.
  • Work closely with care delivery partners, analytics, finance, sales and marketing, claims, UM, credentialing, member services, membership administration, benefits administration and medical group leadership to implement contracting options on time and within budget.
  • Develop and quantify strategic options for network development and expansion including, but not limited to:

o    Identifying contract options and targeted providers
o    Establishing short and long range contractual terms
o    Developing pricing models across multiple facilities, service lines, service levels and programs
o    Maximizing contract leverage
o    Preparing reports on the cost of contracted services

Minimum Education 
  • Bachelor’s degree or equivalent experience in business, finance, healthcare administration or related field.
Minimum Work Experience 
  • Minimum of 5 years progressive responsibility and quantifiable results in network development and delivery system negotiations. Requires minimum 3-5 years of that experience to be in contracting for hospitals, health systems or other highly strategic contracting of equal complexity.
  • Strong influencer; demonstrated contributor to building and upholding a positive team culture.
  • Strong financial acumen – must possess extensive knowledge of hospital, physician, skilled nursing, and ancillary provider reimbursement models for commercial and government payers, including pay for performance models.
  • Minimum five years experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
  • Knowledge of network development, provider network clinical and business operations, provider relationship management, reimbursement analysis, contract performance analysis.
  • General knowledge of legislative and government activities and marketplace issues affecting the region preferred.
  • Comprehensive knowledge of Medicare and Medicaid payment methodologies, level of care pricing, and federal and state health care regulations.
  • Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiations, interpersonal relations, oral and written communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation and project management.
  • Must be a “self-starter” with a strong sense of initiative and follow-through. Ability to work independently under high-pressure circumstances with little or no supervision.
  • Software skills including Microsoft Word, Excel, PowerPoint, Access, Project, and Visio preferred.
Click here to download and review the full Job Description, Experience and Qualifications.

Contact us! main@omgma.com | 971-373-1477 | P.O. Box 790, Sherwood, OR 97140

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