JOB OBJECTIVE 

The Contracting and Network Development Manager (Manager) plans, directs, and coordinates Clinicas’  policies, goals, and objectives related to contract language and rate pricing, negotiation strategy, planning and execution, revenue reconciliation, and payer and provider network relationship management.  The Manager provides leadership, financial and administrative oversight of the provider contracted network as well as both managed care and non-managed care contracting and operations with commercial, Medicare, and Medi-Cal payers on behalf of the organization and other related ventures.    

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES 

The Manager is responsible for performing the following duties: 

• Develop and manage a portfolio of payer contracts that optimize organization revenue, margin and growth in alignment with Clinicas’ mission and strategic objectives 
• Work closely with Utilization Management and Clinical heads to identify any gaps in provider network.  Use technology/software to identify gaps in the network.  Pursue and negotiate consequent contracts.  This will require regional travel. 
• Establish and maintain positive, appropriate relationships with market payers and network providers. Utilize communication and organizational skills to work collaboratively and credibly to achieve common objectives. 
• Work collaboratively with internal stakeholders including Operations, Finance, Claims, Utilization Management, and Credentialing to define and achieve common payer strategy and reimbursement objectives.    
• Develop and execute communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace. 
• Coordinate financial analysis of payer and provider contract performance and modeling projections based on alternate contract agreements with payers, providers, adverse trends, etc, and make appropriate recommendations or conclusions. 
• Analyze and monitor financial aspects of existing managed care contracts.  Utilize analysis for feedback on contract renewals, renegotiations or termination.  Make recommendations regarding participation or non-participation with new or existing agreements.  Provide feedback regarding financial and/or operational issues with payers and providers. 
• Responsible to ensure contract language is in compliance with Federal, State, Industry and Clinicas’ standards and guidelines.  
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team. 

EDUCATION, EXPERIENCE AND QUALIFICATIONS 

Bachelor’s Degree in Business, Public Administration or a health related field is required. Master’s in Business, Healthcare Administration or related field is preferred.  Minimum 7 years in health care or managed care industry.  Previous experience in the provider industry or contract management is highly preferred. Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, provider networks, hospitals and health insurance benefit plan designs. Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies.  Highly developed communication and organizational skills. Experience assessing problems & implementing solutions.  Reliable transportation is required.