Contracts Manager

Essential Functions:

? Recommends strategy then negotiates Provider contract terms and rates based on identifiable opportunities to enhance revenue, reduce costs and limit financial risk.

? Assesses contract proposals, recommends action, respond to RFPs.

? Maintains relationships with health care providers. Promotes open communication in addressing issues and solving problems. Acts as a liaison between the Hospital and the Foundation.

? Monitors contract performance by analyzing rate structures, utilization trends and profitability.

? Develops and maintains working relationships with other Hospital?s and Foundation departments to assure quality of care and service and to promote the cost effective delivery of health care services.

? Serves as a resource to Hospital departments in respect to contracting issues.

? Assists in Regional Contracting activities.

 

Additional Responsibilities: 

? Assists and supports Medical Director with respect to contracting issues and establishing rate structures.

? Performs analytical analysis and special projects that may be assigned by the Regional Vice President of Contracting, Vice President of Contracting and/or the Executive Management Team.

? Serves as a resource for contract interpretations and claims resolutions.

 Knowledge / Skills / Abilities

? Must be able to assume a high degree of independent functioning, demonstrating prudent decision making and flexibility.

? Must have a solid understanding of Fee-for Service, Capitated, Per Diem and Case Rate contracts, including a practical working ability with legal documents and case management concepts.

? Must possess excellent verbal and written communication skills and an ability to work effectively with others.

? Requires an in-depth knowledge of health care operations and health care planning functions.

? Must possess a ?hands-on? working knowledge and at least two years of experience using micro-computer systems and applications.

? Must possess an understanding of financial accounting methods.

? Must have analytical skills.

? Must have fundamental understanding of the State and Federal health care guidelines for reimbursement.

? Demonstrate a flexible attitude of team building, cooperation and professionalism.

? Must have the ability to work closely and effectively with others.

? Must have the ability to consistently function in an environment that includes varying unpredictable or crisis circumstances while exercising appropriate interpersonal and critical thinking skills.

 

Age-Related Competencies: None



Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.  

 

Risk Management: Cooperates fully in all risk management activities and investigations.  

 

Safety Requirements: Is knowledgeable of, observes and complies with Codes of Safe Practice, safety policies and emergency procedures.

 

Minimum Position Qualifications:

 

? A four year college degree.

? Four years contract management/Provider relations experience within the health care industry.

? Four years experience negotiating HMO/PPO, Physician/Group, Hospital and Ancillary contracts.

? License or Certification requirement: NONE

 

Preferred Position Qualifications:

 

? A masters degree in a health-care management and/or business administration field.

? Five years + contract management/provider relations experience within the health care industry.

? Five years + direct contracting experience negotiating HMO/PPO, Physician/Group, Hospital and Ancillary contract in an integrated setting.

 

Environmental Conditions:

? Subject to fast paced environment.

? Subject to long irregular hours.

? Subject to multiple calls, inquiries and special projects requiring critical deadlines.

 

Physical Requirements:

? Must have the ability to travel

? Attend off site meetings.

? Must be able to carry up to 25 pounds.