Job Description
Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring - monitoring - and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cost and competitive data for the development of contracting strategies.
Essential Responsibilities:
- Contract Negotiation: Negotiates financially competitive and predictable contracts. This includes participating in collaboration with Actuarial Services and internal advisors when appropriate. Evaluates multiple suppliers through a pre-screening process to evaluate a suppliers opportunity to provide the best quality, price and service, including reviews of supplier dependability and financial solvency. As a result of the pre-screening process, may eliminate potential suppliers from consideration and further contract negotiations.
- As part of contract negotiations, determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.
- Prepares a business profile for each potential supplier. The profile indicates the solvency and credit-worthiness of the supplier and to check for any potential problems in the supply chain. This profile is to include: A favorable review of the List Validation and reporting (LVAR) report. A favorable Dunn & Bradstreet Report. Evidence of a robust Quality Program. A review of the Professional Liability & General Liability and Property Damage Insurance minimum limits of $1 million per occurrence, $3 million aggregate (or state regulated limits). Current Licensure, Accreditation and/or Certification.
- Servicing Regional Stake Holders: Responsible for communications, assessments, identifying network needs, strategy development, financial, implementation, forecasting, etc. May take responsibility, on a periodic basis, for facilitating and direction setting for stake holder meetings and communications. Evaluates regional stake holder business needs, and selects, from multiple approaches, the appropriate consultative approach to ensure successful interactions and outcomes. Responsible for employing account management and customer relationship concepts and techniques to ensure service excellence.
- Collaboration & Coordination with Provider Relations: This includes provider implementation, communications (provider manual, community provider portal, etc.) maintenance of provider contract files (paper & web), provider data base, provider training, and system configuration quality control.
- Network Monitoring: Responsible for generating or coordinating the development of metrics, including financial analysis, supplier oversight, network adequacy (accessibility & capacity), member satisfaction, supplier integrity, business continuity, product recall, etc. May be responsible for providing input into determining appropriate next steps. Oversees development of suppliers corrective action plans and ensures submitted plans meet quality and business process standards. Accountable for ensuring suppliers/suppliers are responsive to quality and service level concerns and influencing stakeholders to ensure that interventions are timely and effective.
- Regulatory Compliance: Ensures regulatory and statutory compliance of provider contracts and executes on remediation efforts as determined by senior contract managers and leadership. Accountable for ensuring supplier/suppliers are educated on and adhering to the KP Supplier Integrity program. Responds to audit requests for both internal and external audits and develops corrective actions plans, as appropriate.
Basic Qualifications: Experience
- Minimum five (5) years minimum relevant experience.
- Minimum three (3) years of managed care provider contracting or provider relations experience.
- Bachelors degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
- N/A
- MS Word, Excel, Access, Visio & PowerPoint.
- Thorough knowledge of provider contracting policies, practices and systems.
- Complete understanding and broad application of principles, theories, concepts, practices, and standards in contract negotiation strategies and techniques.
- Full knowledge of health care industry content practices.
- Must be able to work in a Labor/Management Partnership environment.
- Minimum five (5) years of managed care provider contracting, or provider relations management experience preferred.
- Minimum two (2) years of health plan operations cross-functional experience (i.e., claims, customer service, quality & utilization management) preferred.
- Masters degree preferred.
Manages and conducts specific functions of the contracting and provider relations process. This includes sourcing of providers, the RFP process, contract negotiation, problem-solving, measuring - monitoring - and reporting on the status of contract agreements and relationships. A significant focus includes the collection and analysis of cost and competitive data for the development of contracting strategies.
Essential Responsibilities:
- Contract Negotiation: Negotiates financially competitive and predictable contracts. This includes participating in collaboration with Actuarial Services and internal advisors when appropriate. Evaluates multiple suppliers through a pre-screening process to evaluate a suppliers opportunity to provide the best quality, price and service, including reviews of supplier dependability and financial solvency. As a result of the pre-screening process, may eliminate potential suppliers from consideration and further contract negotiations.
- As part of contract negotiations, determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.
- Prepares a business profile for each potential supplier. The profile indicates the solvency and credit-worthiness of the supplier and to check for any potential problems in the supply chain. This profile is to include: A favorable review of the List Validation and reporting (LVAR) report. A favorable Dunn & Bradstreet Report. Evidence of a robust Quality Program. A review of the Professional Liability & General Liability and Property Damage Insurance minimum limits of $1 million per occurrence, $3 million aggregate (or state regulated limits). Current Licensure, Accreditation and/or Certification.
- Servicing Regional Stake Holders: Responsible for communications, assessments, identifying network needs, strategy development, financial, implementation, forecasting, etc. May take responsibility, on a periodic basis, for facilitating and direction setting for stake holder meetings and communications. Evaluates regional stake holder business needs, and selects, from multiple approaches, the appropriate consultative approach to ensure successful interactions and outcomes. Responsible for employing account management and customer relationship concepts and techniques to ensure service excellence.
- Collaboration & Coordination with Provider Relations: This includes provider implementation, communications (provider manual, community provider portal, etc.) maintenance of provider contract files (paper & web), provider data base, provider training, and system configuration quality control.
- Network Monitoring: Responsible for generating or coordinating the development of metrics, including financial analysis, supplier oversight, network adequacy (accessibility & capacity), member satisfaction, supplier integrity, business continuity, product recall, etc. May be responsible for providing input into determining appropriate next steps. Oversees development of suppliers corrective action plans and ensures submitted plans meet quality and business process standards. Accountable for ensuring suppliers/suppliers are responsive to quality and service level concerns and influencing stakeholders to ensure that interventions are timely and effective.
- Regulatory Compliance: Ensures regulatory and statutory compliance of provider contracts and executes on remediation efforts as determined by senior contract managers and leadership. Accountable for ensuring supplier/suppliers are educated on and adhering to the KP Supplier Integrity program. Responds to audit requests for both internal and external audits and develops corrective actions plans, as appropriate.
Basic Qualifications: Experience
- Minimum five (5) years minimum relevant experience.
- Minimum three (3) years of managed care provider contracting or provider relations experience.
- Bachelors degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
- N/A
- MS Word, Excel, Access, Visio & PowerPoint.
- Thorough knowledge of provider contracting policies, practices and systems.
- Complete understanding and broad application of principles, theories, concepts, practices, and standards in contract negotiation strategies and techniques.
- Full knowledge of health care industry content practices.
- Must be able to work in a Labor/Management Partnership environment.
- Minimum five (5) years of managed care provider contracting, or provider relations management experience preferred.
- Minimum two (2) years of health plan operations cross-functional experience (i.e., claims, customer service, quality & utilization management) preferred.
- Masters degree preferred.
About Kaiser Permanente
At Kaiser Permanente, we’re all focused on helping people and providing high-quality, affordable health care services and to improve the health of our members and the communities we serve. Across our organization, we’re fiercely committed to our members, our mission, our communities, and each other. We know that each part of the Kaiser Permanente team is essential to our success. Together, we are more than 235,000 dedicated professionals working to advance Kaiser Permanente’s commitment to delivering a healthier tomorrow.
Driven by our collective passion at Kaiser Permanente, we strive to make health care more innovative and compassionate. With the wellness of our patients and our communities at heart, we work to revolutionize health and care from more than 650 locations in 8 states and D.C.
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