The Contract Manager is responsible for negotiating agreements with integrated healthcare delivery systems, hospitals, ancillary providers, physicians and physician groups that result in the Prime Healthcare EPO Tier 1 network having high quality, cost effective and marketable providers. This position is accountable for ensuring effective implementation of new as well as renewed contracts through communication and coordination with other functional areas. This position creates, negotiates and incorporates Prime Healthcare EPO Tier 1 contract amendments as well as renegotiating contracts to accommodate scope changes or changes in organization requirements. This position may lead related initiatives and projects. Travel is required.
Note: This position is not responsible for the Prime Healthcare Employed Physician Groups but is expected to integrate with them.
Ensures effective implementation of new and renewing contracts through communication and coordination with other functional areas Note:Only for Contracted but not Employed Physician Groups.
Obtains the corresponding credentials and maintains the contract files in an orderly manner.
Follow up with physicians and/or vendors on the status of a contract and/or missing information.
Efficiently and effectively obtains and audits files of the Hospitals’ privileged providers and keeps the UR department abreast of changes including addition and termination of providers monthly.
Ensures the efficient management of the Prime Healthcare Benefit Department’s provider contracts; including maintaining the master contract file.
Adheres to Prime Healthcare contracting policies, procedures and financial guidelines
Initiates Letter of Agreement (LOA) process as requested by Prime UR.
Processes provider contracts received in a timely manner (one business week turn around).
Provides directory updates monthly to Prime UR and Claims Departments plus TPA and On-line Enrollment Vendor
Maintains the current Directory intranet load for all Prime facilities. Manages and controls the contractual relationship with contracted but not employed providers
Gathers relevant data regarding financial and operational performance as well as other competitive information.
Collates and distributes new provider Welcome Packs, new hospital Provider Packets.
Performs necessary analysis of cost and utilization data in addition to the analysis of the financial and operational impact of contractual proposals
Ensures corporate goals and objectives for approved initiatives and projects are completed within established timeframes and financial parameters
Performs other duties as assigned or required.
EDUCATION, EXPERIENCE, TRAINING
Bachelor’s degree in Health Care Administration or related field or equivalent work experience required and five (5) years’ experience in Self-Funded Plans, OR
Master’s degree in Health Care Administration or Management and four (4) years’ experience in Contracting model setting, OR
Any appropriate combination of education and experience.
Ability to travel
Experience with Self-Funded Plans
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: [ Link removed ] - Click here to apply to Contracts Manager
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Job ID: 2020-44091
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