Director II (Contracting)
Job DescriptionWhy CalOptima?
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.Job Summary
The Director II (Contracting) leads the Contracting department and is responsible for the development and implementation of contracting strategies for providers and other business entities, management and monitoring of contractual relationships with existing provider networks and contractors. The incumbent conducts and coordinates financial analysis to determine and design contracting strategies for CalOptima and negotiate provider contracts. Position Responsibilities:
Possesses the Ability to:
- Cultivates and promotes a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
- Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short and long-term goals/priorities for the department.
- Directs a complex service delivery network through diverse contracts.
- Manages employees directly including selection, training, performance management, goal setting and ensuring departmental compliance with regulations and internal and external guidelines.
- Coordinates with the executive team and legal affairs to prepare, write and/or oversee the writing of contract language; update contracts and related materials.
- Serves as a liaison, develops and provides strategic direction in relation to organization contracting needs.
- Recruits' providers, as required, to ensure member access and availability to care.
- Evaluates contract performance, identification, analysis and resolution of problem areas, communicate findings to staff with recommendations for performance improvement.
- Negotiates compensation rates with providers within specified limits as authorized by the Board of Directors.
- Maintains all current and historical contract documents and database.
- Prepares CalOptima Board Action Agenda Referrals (COBARs) and presents to the Board of Directors as needed.
- Enhances the relationship with providers by providing relevant data, responding to requests for information, and by resolving issues related to capitation, claims, and other operational functions.
- Utilizes understanding of the business risk relationships to interact and influence provider and identify key types of contracts that need to be negotiated.
- Maintains internal awareness of network changes; issues timely and accurate provider update communications about contractual arrangement changes, provider terminations, changes and additions.
- Oversees the preparation of concise and clear reports for submission to regulators, the CalOptima Board of Directors, executive management or others as required.
- Ensures compliance; responds to grievances/appeals and adheres to regulatory and departmental policy and procedure guidelines and timeframes.
- Develops and implements provider contracting policies and procedures, metrics, desk top procedures and quality improvement plans.
- Completes other projects and duties as assigned.
Experience & Education:
- Motivate and lead staff.
- Manage projects including cross functional teams across all levels in the organization.
- Establish and maintain working relationships with CalOptima leadership and staff.
- Communicate clearly and concisely, both verbally and in writing.
- Identify pertinent policy issues and develop strategies, solutions and procedures.
- Direct, organize and track numerous and multiple activities, timelines and issues.
- Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
- Bachelor's degree in Business Administration, Healthcare Administration or related field required.
- 7 years of experience in health care, including network or health service contracting for an integrated system or managed care organization and a minimum of 3 years of experience working with a delegated system of health care required.
- 5 years of supervisory/management experience required.
- Recent experience in contracting all types of provider contracts for Medi-Cal and Medicare Advantage products required.
- Experience with administration of Medi-Cal and Medicare programs required.
- Master's degree in Healthcare Administration or related field preferred.
- Health insurance plan operations and delegated risk model contracting.
- Individual Practice Associate (IPA) or medical group managed care operations.
- Principles and practices of health care, health care systems, and managed care.
- Knowledge of rules and regulations associated with Medi-Cal Department of Health Care Services (DHCS), Medicare Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care (DMHC), Knox Keene act.
- CalOptima program, organizational structure and operations.
- Health, social and other needs of Orange County residents who are eligible or potentially eligible for the Medi-Cal and dual eligible programs.
- Principles and techniques of effective administration and supervision, including training and evaluation.
- Techniques of project planning and management, program and policy development, administration and coordination.
- Contract management software and databases.
Executive Director, Network OperationsFLSA status:
R - $69.23 - $107.88 ($144,000 - $224,400)CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3895Copyright ©2022 Jobelephant.com Inc. All rights reserved.
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