Manager Contracts Out of State - SHP Finance - Remote - Day Shift - Full Time

Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$64.350 - $83.040 - $101.720

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

Please Note: As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do
Manage all Sharp Health Plan facility and ancillary contracts and coordinate negotiations to minimize financial risk and legal issues, while communicating contractual terms to ensure smooth administration. Multiple products and service lines, including but not limited to, HMO, PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange. Contract types to include capitation, fee for service, per diem, medical service agreements, service agreements, P4P, and other risk adjusted agreements as developed in conjunction with health care reform. Ensures effective management of SHP contracting to include network assessment and cost control. Ensures fair and reasonable rates of reimbursement within appropriate terms and conditions. Ensures accurate completion of contracts to include language review, appropriate signatures, etc.

Provide plan wide strategy and support through contract analysis, consultation in new program development, and assist in contract reimbursement modeling for the annual budgeting process, and development and management of Sharp Health Plan projects as a result of legislation. Responsible for operational support system to respond to contract informational needs and monitor facility and physician issues regarding contracting priorities. Provide operational support to internal and external customers.
Participates as part of and in support of the overall Sharp Health Plan management team that works to ensures success in reaching Sharp Health Plan goals and objectives.

Required Qualifications

• 3 Years experience in health care at a position in contracting.

Preferred Qualifications

• Master's Degree
• General hospital, medical or other clinical experience.

Other Qualification Requirements

• Bachelor degree in Accounting, Finance, Business Administration or Health Care Administration or similar equivalent health care experience is required.

Essential Functions

• Contract Management
  Responsible for all professional, facility, ancillary, medical group contracts, employer and broker contracts, service agreements, Letters of Agreement and any other contracts (as determined by CEO and CFO) to include analysis, negotiation, etc. Responsible for the updates and maintenance of the SHP contracts database.
  Develops and maintains mutually beneficial working relationships with providers. Responds to inquiries from new, potential vendors in support of the Sharp Health Plan mission, values and philosophy.
  Ensures ongoing analysis of provider contracts changing plans as necessary based upon the outcome of those analyses. Consistently strives to improve contract performance.
  Demonstrates ability to respond to requests and independently provides key information to the executive team, Director of Medical Economics & Contracting or SHP departments regarding all assigned contracts. Insure timely response to contractual issues and contract compliance problems. Responsible to notify contracted providers of any contract or regulatory changes that may significantly impact their practices.
• Contract Analysis
  As directed, provides insight and analysis on contractual requirements and obligations for new product lines pursued by Sharp Health Plan, including but not limited to PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange.
  Works in conjunction with SHP staff to design and implement co