Contract Manager (Senior)
Northwest Permanente is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 500,000 members in OR and Southwest WA. We are searching for a Sr. Contract Manager to manage an assigned portfolio of NWP-contracted practitioner relationships and KFH contracted provider relationships in a manner consistent with (1) NWPs Objectives, (2) KFHPs Objectives, (3) MDQR Accreditation Requirements, (4) NCQA Accreditation Requirements, and (5) applicable Federal and State Legal/Regulatory Requirements.
Job Post Date: 2017-10-18
Office: Kaiser Permanente Bldg
Northwest Permanente is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 500,000 members in OR and Southwest WA. We are searching for a Sr. Contract Manager to manage an assigned portfolio of NWP-contracted practitioner relationships and KFH – contracted provider relationships in a manner consistent with (1) NWP’s Objectives, (2) KFHP’s Objectives, (3) MDQR Accreditation Requirements, (4) NCQA Accreditation Requirements, and (5) applicable Federal and State Legal/Regulatory Requirements.
- 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 includes facilities, individual and group medical practices, using a diverse range of techniques and contracting 'best practices', to include DRGS, per diems, case rates, 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.
- 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 negotiations.
- Minimum of 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.
- Extensive knowledge of hospital, physician, and ancillary provider reimbursement methods for commercial and government payers, including pay for performance models.
- 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.
All external hires are required to pass a pre-employment background screen.
Northwest Permanente, PC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with a disability.