Director, Managed Care Contracting
Full Time - Regular
Roseburg, OR, US
This position will prepare, review, monitor or maintain provider contracts, leases and other contractual agreements; ensure compliance of applicable rules and regulations; research and prepare reports as needed; and serve in an administrative capacity for all contract matters.
ESSENTIAL JOB RESPONSIBILITIES
- Responsible for CCO VBP contract proposals and reporting.
- Partner with Quality and Network Operations as needed.
- Produce proposals for contract rates and value based care (VBC) arrangements, along with reporting framework and benchmarks.
- Analyze and report CCO VBP performance, partnering with Quality, and coordinating with Finance re: appropriate contract accruals.
- Manage contracting staff.
- Collaborate with the Finance and Data Support Departments in identifying contracting and network development strategies.
- Work with Network Operations and Leadership in designing, developing and negotiating provider contracts, including identifying alternative payment methodologies.
- Maintain contracts in accordance with appropriate record retention procedures and internal controls.
- Develop and prepare performance specifications and requests for proposals.
- Establish schedules and methods to ensure contract compliance, including required timely payments, and document management. Review needs with management for allocation.
- Participate in the development of policies and procedures. Make recommendations for change and improvements to existing standards and procedures.
- Provide various agreement information to potential tenants, consultants, contractors, developers, legal counsel and other external entities.
- Prepare and complete required agreement information, documents, drafts and amendments. Enter information into computer system, prepare correspondence for approval, and validate contract assignments.
- Manage the interface and related workflows with external legal counsel and external legal specialists.
- Collaborate with Umpqua Health's Compliance Department on matters pertaining to contract compliance and vendor performance.
- Prepare analytical and statistical reports on operations and activities, as applicable.
- Attend and participate in professional group meetings as needed.
- Lead Network Performance Committee and collaborate with Network Operations Manager.
- Comply with organization's internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
- Other duties as assigned.
- Bachelor's degree with major coursework in business administration or a related field + 2 years of contract development, contract management or related experience.
- Principles and practices of research, analysis and report preparation. Able to prepare clear and concise reports.
- Oversight, principles and practices of contract compliance.
- Strong English usage, spelling, grammar and punctuation.
- Knowledge of pertinent Federal, State and local laws, codes and regulations.
- Ability to interpret and explain Oregon Health Authority policies and procedures, experience with Oregon Health Plan preferred.
- Excellent verbal and written communication skills as well as outstanding problem solving, organizational, and leadership skills.
- Proven strong project management, multi-tasking and presentation skills.