Provider Contracting Director jobs in Clackamas, OR

Overview

The Senior Contract Manager manages an assigned portfolio of contracted provider relationships in alignment with organizational objectives, accreditation requirements, federal and state laws and care delivery needs.  This is a hybrid position that is a blend of working both remotely and in office.

Major Responsibilities / Essential Functions – 

• Identifies outside medical care service needs and opportunities to complement Region’s overall care delivery.
• Develops and maintains relationships with internal and external care providers. Participates in community relations activities to enhance the image and reputation of the organization.
• Negotiates 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 RBRVS, DRG’s, per diems, case rates, value based and other industry standard payment methodologies.
• Partners closely with care delivery, analytics, finance, sales and marketing, claims, utilization management, credentialing, member services, membership administration, benefits administration and medical group leadership to implement contracting options on time and within budget.
• Negotiates key financial and operational terms with hospitals, physicians, practitioners, and ancillary providers in a manner consistent with market strategy utilizing approved contract templates, approved reimbursement methodologies, Kaiser Permanente clinical needs and standards, and applicable laws and regulations. Ensure negotiated terms are accurately and thoroughly documented in contractual agreements.
• Develops and quantifies strategic options for network development and expansion including, identifying contract options and targeted providers, establishing short and long range contractual terms, developing pricing models across multiple facilities, service lines, service levels and programs, maximizing contract leverage and preparing reports on the cost of contracted services
• Monitors contract performance to ensure compliance with contract terms and conditions. Collaborates with Care Delivery leaders in the ongoing clinical, operational, and business management of external provider relationships.
• Coordinates implementation of new contracts as well as administration of existing contracts; work with Provider Relations to assure smooth transition from contracting to service activities.
• Negotiates and facilitate resolution of complex care delivery, claims payment, utilization management, credentialing and/or other operational issues with provider.
• Monitors external healthcare delivery marketplace and internal utilization trends. Assess new opportunities for cost savings, alternative delivery models and financial risk sharing.
• Works with Legal, Regulatory and Compliance to assure that contract templates are compliant.
• Coordinates with Provider and Quality Resource Management Department to ensure timely credentialing of all providers prior to contract being effective.
• Coordinates with Provider Configuration to assure that all contracts are loaded accurately and in a timely manner and to avoid negative impact on claims performance due to retro contracts or inaccurate configuration.

Minimum Qualifications - 

• Bachelor’s degree or equivalent experience in business, finance, healthcare administration or related field.
• Minimum of 5 years progressive responsibility and quantifiable results in network development and delivery system contract 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
• Ability to negotiate cost effective contracts to meet operating budget targets even in an environment where KPNW may hold limited leverage, and provider relationships are challenged due to KPNW’s internalization and integrated care delivery strategies.
• Ability to meet operating budget targets.

Preferred Qualifications –

• Master’s degree in business, finance, healthcare administration or a related field, or equivalent combination of education and experience.
• Minimum of 7 years progressive responsibility and quantifiable results in network development and delivery system negotiations.
• Minimum of 7 years of experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
• Minimum of 5 years progressively responsible management experience at Kaiser Permanente or an HMO/healthcare setting similar in size and complexity to Kaiser Permanente.
• Extensive knowledge of network development, provider network operations, provider relationship management, reimbursement analysis, contract performance analysis required.
• Comprehensive knowledge of legislative and government activities and marketplace issues affecting the region

Join Our Medical GroupNorthwest 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 preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.Equal Opportunity EmployerAt Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.