What are the responsibilities and job description for the Sr. Regional Contract Manager position at SCAN Health Plan?
The Job
The Senior Regional Contracts Manager shall, in concert with the Senior Regional Director and as an integral member of the Network Management team, develop and manage business partnerships with SCAN value-based and fee-for-service provider contracting and network management activities to support achievement of SCAN’s goals including margin, quality measures, and achievement of our mission to enhance senior’s ability to manage their health and live independently.
You Will
- This role is a key contributor who will evaluate, negotiate and prepare contracts in a fiscally responsible manner to ensure a sustainable, high quality, compliant network for assigned regions. Contracts include capitated delegated and fee-for-service medical groups, IPAs and hospitals. Provide direction to internal business units to identify and model expected yield of alternate terms for high spend or increasingly complex provider contracts, monitor actual contract performance, test the feasibility of non-template terms and conditions to identify the most favorable solution and follows appropriate approval process.
- Proactively build relationships that nurture partnerships with SCAN’s contracted network providers, including medical groups, IPAs and hospitals and ensures the network composition includes an appropriate distribution of required professional and facility services.
- Ensure provider contracts accurate implementation and administration. Accountable for assigned provider network performance related to financial, operational, regulatory, quality and member satisfaction targets. Develop and execute provider specific performance improvement plans, based on needs identified via Provider Dashboard metrics that highlight operational, quality, financial and compliance-based measures.
- Utilize contracting knowledge for effective problem resolution and compliance. Responsible for timely and professional interaction in response to contract related inquiries. Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
- Participate in regularly scheduled Joint Operations Committee meetings (JOCs). These meetings will discuss operational issues relative to all parties, including, but not limited to : utilization, financial, enrollment, grievances, provider termination / panel closures, continuity of care, marketing campaigns, etc.
- Responsible for assuring that the day-to-day operations of the provider network are consistent with SCAN standards / expectations. Assist in resolving elevated and complex provider service complaints.
- Act as technical resource on contract related issues and offer strong leadership internally as well as externally. Initiate and maintain effective channels of communication with key internal partners including but not limited to Legal, Compliance, Delegation Oversight, HealthCare Services, Finance, Claims and Sales.
- Participate in interdepartmental meetings and selected committees and substituting for the Senior Director, Regional Network Management on an as needed basis. Provide mentoring to Regional Contracts Managers and other Network Management colleagues.
- Develop goals and objectives, in concert with Senior Director, Regional Network Management that align with the organization’s vision for future growth and network development.
- Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Contribute to team effort by accomplishing related results as needed.
Your Qualifications
What's in it for you?
