Collaborates with regional health plan and medical group stakeholders and executives to negotiate cost-effective, quality-oriented contracts for outside medical services. Negotiates, implements and maintains a diverse group of complex contracts with outside providers and vendors in the areas assigned. Performs network development and provider management/relations activities to achieve regional business goals.
Provides strategic input and assists the senior director in decisions on network design, network adequacy and geographic expansion activities.
Acts as negotiator in complex contract negotiations for the provision of cost effective medical services.
Recommends adjustments to strategies to meet changing business and market conditions. Facilitates executive sponsor meetings as needed for network activities.
Works collaboratively with the medical group in developing and communicating negotiation strategies and tactical approaches.
Assists in the development of contracting, network management and provider relations capabilities within KPCO; developing policies and procedures and best practices to ensure that contracting processes with outside providers support the CO region's business goals.
Builds and maintains collaborative relationships with medical group and health plan leadership and staff including but not limited to claims, UM, sales and marketing, actuarial, operations and finance to ensure successful implementation of key strategic business initiatives.
Assists in the development of contract models and performance standards and assesses contract performance against those standards. Analyzes perspective agreements and recommends action.
Identifies and implements strategies for improvement of the medical loss ratio.
Acts as senior regional consultant to departments regarding contracts and agreements with community delivery systems.
Maintains relationship with current contract providers and vendors to resolve problems.
Reviews key contract provisions with medical group and health plan staff and creates alignment and approval of key provisions. Coordinates with Claims and Referral Administration as needed.
Coordinates implementation/administration of new contracts and coordinates administration of existing contracts; provides input and solutions for resolution of contractual issues.
Incorporates and manages information technology for effective contract management, data analysis, forecasting and reporting.
Contributes to end to end contract management and systems administration capabilities.
Directs the day to day operational activities of the Colorado contracting staff, as appropriate.
Minimum five (5) years of increasingly responsible health care management experience that demonstrates ability in successfully developing and implementing contracting, provider relations and/or network management.
Minimum six (6) years of experience involving quantitative and financial analysis and the management of contracts.
Master's degree in health care administration, business administration or related field with extensive knowledge of health care, compliance/regulatory, clinical and operational matters OR six (6) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Significant knowledge of health care reimbursement methodologies required.
Working knowledge of budget management, negotiating skills and contract language.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
TITLE: Director, Community Contracting (Hospital/Multi-Specialty)
LOCATION: Aurora, Colorado
External hires must pass a background check/drug screen. 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. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.