Duties
The Director of Contracting and Business Development (Director) 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 Director provides strategic 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 Medicaid payers on behalf of the organization and other related ventures. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Develops and manages a portfolio of payer contracts that optimize organization revenue, margin and growth in alignment with Clinicas mission and strategic objectives. Works closely with Utilization Management and Clinical heads to identify any gaps in provider network. Pursues and negotiates consequentcontracts; this will require regional travel. Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations,organizational contractual obligations, and developments in the managed care marketplace. Coordinates financial analysis of payer contract performance and modeling projections. Utilizes analysis for feedback on contract renewals, renegotiations or termination. Responsible to ensure contract language is in compliance with Federal, State, Industry and Clinicas’ standards and guidelines.
Benefits
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas del Camino Real, Inc. offers a highly competitive salary, excellent benefit package, generous holiday, vacation and sick leave.
Requirements
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. Bilingual English/Spanish desirable.
How to Apply
Send applications or resume to: CCareers@clinicas.org Fax: 805-659-3217
Is this job listing for a Provider?
No