Outside Medical Contracts Manager Pasadena, CA
Develops contracting strategies and negotiates contracts for the delivery of services provided by non Kaiser Permanente (KP) providers to KP Health Plan members. Includes accountability to develop and maintain competitive provider agreements. Works in collaboration with Region and Service Area leadership to develop and implement market and service line strategies for care provided by local community providers. Manages the contracting process in an environment of varying reliance on non KP providers. Requires alignment of KFH, SCPMG and Region and Area specific needs.
- Develops and implements competitive market and service line negotiation strategies, in collaboration w/Regional and Service Area leadership, for delivery of health care services to health plan members outside the KP system Conversely, on occasion is able to negotiate contracts on behalf of Kaiser Permanente where we are the seller of health care services to non health plan members.
- Manages a portfolio of contacts and community provider relationships for outside services which may have a significant financial impact on the organization.
- Represents the organization as a primary business spokesperson with the community health care providers.
- Assumes designated regional responsibility for monitoring compliance w/ contractual terms and conditions.
- Is involved in dispute resolution Analyzes, models and negotiates financial arrangements and business/operational terms and conditions with outside providers that meet aggressive cost management objectives.
- Evaluates contact performance and makes recommendations to Region and Service Area leadership with respect to new cost management opportunities.
- Participates in Region and Service Area sponsored initiatives relating to outside providers, which may including make vs. buy analyses, options and opportunity analysis for new contacting strategies.
- Represents the contracting department on internal task forces and committees.
- Monitors health care market place and internal utilization trends to assess new opportunities for cost savings, alternate delivery models and financial risk sharing.
- Bachelor-s degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Educatioin Development (GED) required.
License, Certification, Registration
- Significant experience in health services contacting.
- Strong negotiation skills.
- Excellent understanding of the health care industry, provider community, competitive market strategies.
- Previous experience working with various reimbursement methodologies, financial analysis and decision support systems.
- Demonstrated ability to work independently with a variety of internal and external personnel at various levels of responsibility.
- Strong verbal and written communication required.
- Strong project management, leadership and facilitation skills required.
- Strong analytical skills with experience analyzing medical expenses and utilization.
- Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to customers, contracted providers and vendors.
- Must be able to work in a Labor/Management Partnership environment.
- A minimumfive (5) years of health care experience.
- Experience/knowledge of Word, Excel and PowerPoint.
- Master's degree/MPH/MHSA/MBA preferred.
- Experience in provider contracting, negotiation, understanding of the health care field, project management and facilitation skills.
- Strong analytical skills.
Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St.
Scheduled Hours (1-40): 40
Working Days: Mon, Tue, Wed, Thu, Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Individual Contributor
Job: Healthcare / Hospital Operations
Public Department Name: Affiliated Provider Services
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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