Director, HMO Contracting in Orange at Prospect Medical Systems

Date Posted: 11/17/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    11/17/2020
  • Job ID:
    17106

Job Description



Director, HMO Contracting

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Oversight and ongoing development of the Contracting Department for Health Plan, Ancillary, Full Risk, MSO, Hospital Based Physician and Tertiary contracting. Provide guidance to staff in identifying network needs to negotiate Memorandums of Understanding (MOUs) and contracts with providers to ensure availability and accessibility to members.  Work with legal department to ensure contract templates are revised and updated as needed for state/regulatory compliance and to implement industry standards and/or changes. Audit staff work (contract documents, fee for service agreements, capitation agreements, MOUs) to ensure accuracy and profitability.  Implement department policies and procedures. Provide ongoing staff training.



Job Responsibilities/Duties

  • Develop strategies to strengthen Health Plan contract performance.
  • Develop strategies to strengthen Hospital & Ancillary contract performance.
  • Draft and negotiate Health Plan contracts or renewals as needed.
  • Draft and negotiate Hospital & Ancillary contracts or renewals as needed.
  • Responsible for reviewing contract documents in detail with high level of comprehension and retention.
  • Review financial data and analyze with a view towards defining contracting goals.
  • Manage correspondence to and from health plans for all issues to ensure issues are resolved, new benefits or initiatives are implemented or action is taken as needed.
  • Oversee and manage staff in daily contract negotiations by providing guidance on language and pricing issues.
  • Supervise the day-to-day operation of the Contracting Department by auditing contract drafts, amendments, MOUs and letters to ensure accuracy and profitability, and answering inquiries.
  • Oversee and supervise staff in identifying network needs to ensure availability and accessibility of members.
  • On a routine basis review contract templates to ensure contract requirements, special provisions, term and conditions to ensure compliance with appropriate laws, regulations, policies, business objectives and industry trends. Revise and update contract templates as needed.
  • Ensure timely completion of workflow in order to meet regulatory compliance and departmental turn around time.
  • Provide customer service for internal, as well as, outside inquiries by providing clarity on contractual arrangements and reimbursement structures.
  • Monitor projects to ensure time lines are being met.
  • Prepare and submit requests for financial analysis to finance department in preparation for negotiating new contracts or when renegotiating existing contracts.
  • Schedule, coordinate and attend JOCs and initiate meetings with existing and new providers as needed.
  • Conduct routine one-on-one sessions with staff to discuss workflows, report progress, set goals and, when necessary, identify the need for coaching, mentoring or training and prepare staff for annual evaluation.
  • Monitor attendance, review time off requests to ensure department is adequately staffed, approve and submit timecards.
  • Perform disciplinary actions as needed.
  • Perform annual evaluations


Qualifications

Minimum Education: Four-year College Degree required.    

Minimum Experience: Five (5) years of contracting experience related to healthcare. Sales negotiation experience and supervisory/managerial experience. Ability supervise and manage staff. Must be extremely organized and detailed oriented. Ability to multi-task in a fast-paced environment. Must be able to work under pressure to meet deadlines and turnaround time. Must be able to work independently while staying within boundaries of duties. Proficiency in Word and Excel. Must have intermediate reasoning and problem-solving abilities and planning skills.  Ability to interpret a variety of instructions furnished in written, oral, diagram, and schedule form.  Ability to speak, read, and write English proficiently.  Ability to write business correspondence.   Ability to effectively present information and respond to questions from managers, employees, clients, customers and the general public. 

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Director, Healthcare, Hospitals, Contracting, Contracts, negotiations, planning, financial data, Health plans, Contracts, Hospital Contracts, Ancillary Contracts, Performance, Staff Training, MOU’s, Audits, goals, implementation.



17106