Providence Manager, Provider Contracting in Irvine, California
Providence St. Joseph Health is calling a Manager, Provider Contracting to our location in Irvine, CA.
We are seeking a Manager, Provider Contracting who will negotiate, monitor, manage contracts and maintains relationships on behalf of the Providence Hospital Ministries, St. Joseph Heritage Healthcare, and providers. This individual will also act as a liaison between the Contracting Department and SJHH staff, Network Support Services, and other departments within Providence local Ministries.
In this position you will have the following responsibilities:
Identify and recommend potential provider contracting strategies to reduce costs, limit financial risk, and ensure adequate provider network to service members.
Negotiate provider agreements (physician, hospital, ancillary) within the financial and strategic guidelines established or approved by PSJH.
Establish contracting parameters, revise existing parameters (when necessary), and develop acceptable rates and specific contract provisions to meet needs of SJHH and SJHS Hospitals.
Monitor contract performance against negotiated terms and conditions. Maintain a consistent process and timeline for evaluating contracts and renegotiations.
Work with other departments (e.g. NSS, UM) to resolve contract issues and other problems.
Actively promote positive relations with health care providers. Promote open communication by addressing issues and solving payment and other operational problems.
Manage patient-specific Letters of Agreement. Monitor medical group utilization of non-contracted providers and develop action plans as needed to establish contracts and reduce Letter of Agreement volume.
Treats all information and data within the scope of the position with appropriate confidentiality and security.
Follows all policies developed by the Information Systems Department to support change management, confidentiality, and security.
Respects the dignity, confidentiality and privacy of patients.
Maintains organizational, employee, and patient confidentiality at all times.
Cooperates fully in all risk management activities and investigations.
Reports promptly any suspected or potential violations to laws, regulations, procedures, policies and practices, and cooperates in related investigation.
Conducts all transactions in compliance with all company policies, procedures, standards and practices.
Demonstrates knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
Be subject to fast paced environment.
Be subject to long irregular working hours.
Be subject to multiple telephone calls, tasks, inquiries from other departments.
Be subject to projects requiring critical deadlines.
Some travel required within local area.
Must be able to carry up to 25 pounds.
Required qualifications for this position include:
8 or more experience in contracting and negotiation.
Experience in negotiated agreements within an integrated healthcare deliver organization and managed provider contracting staff.
8 or more years direct contract negotiation with HMOs, PPOs, physicians, physician groups, ancillary providers and hospitals.
Preferred qualifications for this position include:
Master's degree in Business or health care management.
8 or more years direct contract negotiation within an integrated health care delivery system .
About the department you will serve.
Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Req ID: 284691