Northwest Permanente is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 576,000 members in OR and Southwest WA. The Provider Contracting Department is seeking a Contract Manager who will collaborate with NWP and KFHP leadership on projects as assigned by the Associate Director, and the Provider Contracting and Relations Department. The Contract Manager works to ensure the development and maintenance of appropriately performing external contracted providers. This role will perform all duties in a manner which promotes Provider Contracting and Relations team concept and reflects the mission and philosophy of North Permanente.
Job Post Date: 2017-05-15
Office: Kaiser Permanente Bldg
Kaiser Permanente is committed to helping shape the future of health care. As the largest integrated care delivery organization in the United States, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.
Kaiser Permanente Northwest (KPNW)— made up of over 11,000 employees, more than 1,000 physicians and 140 dentists — provides and arranges medical care exclusively for health plan members. In the Portland-Vancouver area, Kaiser Permanente operates 36 medical offices and two hospitals. Today, the Northwest Region serves more than 576,000 medical and 244,000 dental members whose care is largely provided by Northwest Permanente, P.C. (NWP) and Permanente Dental Associates (PDA).
Northwest Permanente is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 576,000 members in OR and Southwest WA. The Provider Contracting Department is seeking a Contract Manager who will collaborate with NWP and KFHP leadership on projects as assigned by the Associate Director, and the Provider Contracting and Relations Department. The Contract Manager works to ensure the development and maintenance of appropriately performing external contracted providers. Appropriate performance encompasses clinical, customer service, access, utilization, and fiscal provider performance that meets and/or exceeds NCQA and MDQR standards. This role will perform all duties in a manner which promotes Provider Contracting and Relations team concept and reflects the mission and philosophy of North Permanente.
MAJOR ACCOUNTABILITIES / ESSENTIAL FUNCTIONS
- Identifies and/or anticipates outside medical care service needs and opportunities to complement Region’s overall care delivery. Collaborates with 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 may include facilities, individual and group medical practices, using a diverse range of techniques and contracting ''best practices'', to include DRGS, per diems, case rates, CMS RBRVS and other industry standard payment methodologies.
- Negotiate key financial, operational and legal terms with hospitals, physician and ancillary providers in a manner consistent with market strategy utilizing approved contract templates, approved reimbursement methodologies, KP clinical needs and standards, and applicable 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:
- 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
- Preparing reports on the cost of contracted services
- Identifying trends and then using a team-based approach to evaluate options for change
- Monitor contract performance to ensure compliance with contract terms and conditions. Collaborate with Care Delivery (DA’s, Chiefs) in the ongoing clinical, operational and business management of external provider relationships
- Coordinate implementation of new contracts as well as administration of existing contracts; work with Provider Relations to assure smooth transition from contracting to service activities
- Negotiate and facilitate resolution of complex care delivery, claims payment, utilization management, credentialing and/or other operational issues with provider
- Monitor external healthcare delivery marketplace and internal utilization trends. Assess new opportunities for cost savings, alternative delivery models and financial risk sharing
- Work with Legal, Regulatory and Compliance to assure that contract templates are compliant.
- Ensure that contracts can be administered within KPNW systems.
- Meet all regulations related to the sphere of contracting.
- Coordinate with Provider and Quality Resource Management Department to ensure timely credentialing of all providers prior to contract being effective.
- Coordinate with Director, Provider Contract Analytics and Reimbursement, and other analytical staff to develop analyses and payment strategies that will result in cost effective contracts.
- Coordinate 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 EXPERIENCE AND QUALIFICATIONS
- Bachelor’s degree or equivalent experience in business, finance, healthcare administration or related field.
- Minimum of three to five (3 -5) years progressive responsibility and quantifiable results in network development and delivery system negotiations.
- Extensive knowledge of hospital, physician, and/or ancillary provider reimbursement methods for commercial and government payers, including pay for performance models.
- Minimum five (5) 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.
- 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.
- 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. Strong influencer; demonstrated contributor to building and upholding a positive team culture.
- Software skills including Microsoft Word, Excel, PowerPoint, Access, Project, and Visio preferred.
- Budget Responsibility: The Contract Manager has no direct KPNW operating budget responsibility, per se, since the Contract Manager negotiates contracts which are part of the overall budget responsibility of a NWP Service Chief/Department Administrator or a KFHP Operations Leader (e.g. the Director of Continuing Care Services). It should be noted, however, that the Contract Manager has significant influence on KPNW’s operating budget in their ability to negotiate cost-effective financial terms and payment strategies.
- Ability to negotiate cost effective contracts to meet operating budget targets in an environment where KPNW holds little to no leverage, and provider relationships are challenged due to KPNW’s internalization and care delivery strategies.
- Ability to meet operating budget targets.
- Able to consistently satisfy demanding internal clients and to handle the constant pressure of multiple simultaneous projects with competing priorities and deadlines.
- Due to the demands placed upon the Provider Contracting Department, the pace is rapid and dynamic, sometimes causing project priorities to rapidly and significantly shift. Ability to work in a high-pressure environment with sometimes limited resources while expected to meet aggressive project timelines.
- Internal Project Team Skills
- Ability to develop & maintain trusting relationships with internal KPNW staff and leadership.
- Ability to listen to KPNW Clinical Leadership’s care delivery needs in contracted provider relationships and associated operating budget constraints, and to translate these needs into an effective contracted relationship.
- External Practitioner/Provider Skills
- Ability to develop & maintain trusting relationships with contracted providers (Physicians, Physician Administrators, Hospital CEO’s, COO’s and CFO’s.
- Ability to consistently and effectively negotiate sound contracts with targeted providers utilizing astute management of each stage of the negotiation; appropriately escalating outstanding business and clinical issues to leadership.
- Ability to work effectively and diplomatically with the leadership of contracted providers to address contract interpretation, performance, and enforcement issues.
- Ability to work effectively and collaboratively with representatives from other NWP and Health Plan departments, and/or other KP regions.
- The stress level can be above average at times due to the difficulty of negotiating provider contracts within prescribed deadlines and operating budgets.
- In order to meet with physicians, providers and/or other administrative staff when they are available, there are frequent early morning and early evening meetings.
- Position will require some overnight travel around the Pacific Northwest.
- Position will require accessing some non-Kaiser provider offices which may not be ADA accessible.
REQUIRED LICENSURE, CERTIFICATION, REGISTRATION
- Valid Oregon or Washington driver’s license and active auto insurance
PREFERRED EXPERIENCE AND QUALIFICATIONS
- Masters Degree in business, finance, healthcare administration or a related field
- Minimum five to seven (5-7) years progressive responsibility and quantifiable results in network development and delivery system negotiations.
- Minimum five to seven (5-7) 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 five (5) years progressively responsible management experience at Kaiser Permanente (preferred) 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.