Sutter Health Manager-Provider Contracting & Managed Care Full Time Day Shift in Lafayette, California
The Sutter East Bay Medical Foundation is a not for profit corporation that exists to provide medical services, research and education. The foundation provides the infrastructure for the delivery of physician services, and contracts with a separate corporation comprised of physicians and other care providers to deliver the clinical services. This multi-specialty foundation will provide a platform from which new physicians can be recruited to continue to provide physician services in a nonprofit, community setting. The Foundation's vision is to create a medical group that will deliver high quality, market competitive medical services.
The Provider Contract Manager is primarily responsible for directing, planning and managing the payor and provider managed care agreements for Sutter East Bay Medical Foundation; including all Specialty, Ancillary, Hospital, Primary Care, and IPA contracts. This position also has oversight and responsibility for the administration of SHEBR Global Capitation product lines. This position works closely with SPS to ensure the functions of Credentialing and Enrollment for all SEBMF and EBPMG Providers are accurate and completed timely. The Provider Contracting Manager has oversight of the on-boarding process to ensure all providers and departments are loaded into Epic timely and accurately. The Provider Contract Manager will be the Lead Liaison for the East Bay Region for the Sutter Health Plus Managed Care Plan.
Minimum Job Requirements :
Requires a Bachelor’s degree in; Business Administration, Finance, Health Management or equivalent combination of education and experience in health care administration field. Master’s degree desirable.
The position requires at least 7 to 10 years of prior experience negotiating managed care contracts in a hospital, physician, medical group or health plan setting, with strong results-oriented negotiating skills. Must have experience in personnel management, budget preparations and planning; experience in project management with third party administrator and regional stakeholders. Incumbent should be able to demonstrate leadership and communication skills and ability to interact with all levels including regional senior management to provide recommendations to influence decision making.
Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis. Posses advanced understanding of various managed care reimbursement models, pricing mechanisms, and financial concepts. Thorough knowledge of health care benefit plans, online systems, and flow of related information. Knowledge of governmental and healthcare fiscal regulations and reporting requirements as it relates to Knox-Keene, Department of managed Care, HIPPA, CMS, Medi-Cal Managed Care.
Special Skills and/or Equipment Used:
Must have the ability to effectively negotiate contract arrangements with; physicians, vendors and payers. Demonstrated excellent communication skills are a must for this position to enable the incumbent to case understanding and agreement to terms of the contracts. Must be able to establish and maintain effective working relationships with physicians, vendors and their staff. Demonstrated managerial skills including the ability to oversee and delegate responsibility to staff. Ability to communicate effectively in written and oral form in the English language is essential. Skills in data base management and word processing are required. The ability to be self started and self directed in work habits.
Primary Location: California, East Bay, Lafayette
Organization: Sutter East Bay Medical Foundation
Employee Status: Regular
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.