Job Description

For more details please connect with Ibad Ullah Khan at or email at

Client: CalOptima Health
Job Title: Contracts Manager

Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: Web Interview

Working Hours: 40 Hours a Week Monday to Friday Full InOffice (8am to 5pm)

Ceipal ID: CALHD413IK

Position ID: 413

W2 Payrate (Without Benefits): $43.66/Hour

Department: Contracting

Description:

• CalOptima Health is seeking a highly motivated an experienced Contracts Manager to join our team.
• The Contracts Manager will be responsible for developing maintaining and negotiating contracts with health networks professional ancillary facility providers including processing Letters of Agreement (LOA).
• The incumbent will participate in network development physician recruitment rate proposal analyses negotiations and coordination to ensure appropriate and timely implementation of provider contracts and provider networks as assigned.
• The incumbent will support contracts approved by the Board of Directors and Provider Network Operations leadership.

Duties & Responsibilities:

80% Program Support

• Contracting Functions Negotiates implements and manages provider network contracts health networks professional ancillary and facility providers as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to innetwork providers as needed.
• Maintains and reports the status of LOA dispositions develops action plans to transition noncontracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing networkwide contract initiatives.
• Coordinates with legal Medical Management Provider Relations Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problemsolve provider contracting issues.
• Negotiates implements and manages provider network contracts health networks professional ancillary and facility providers as assigned.
• Negotiates LOA for members being directed to out of network providers for covered services reviews requests for accuracy and appropriateness and attempts to identify opportunities to redirect member(s) to innetwork providers as needed.
• Maintains and reports the status of LOA dispositions develops action plans to transition noncontracted providers to full contracts when possible and collaborates with other staff to monitor and expedite the credentialing/contracting process.
• Optimizes and maintains accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
• Manages project plans when implementing networkwide contract initiatives.
• Coordinates with legal Medical Management Provider Relations Finance and OneCare Sales and Marketing to implement new and renewing provider contracts.
• Monitors performance and utilization trends of assigned networks to assess new opportunities for cost savings alternate delivery models and financial risk sharing through contractual arrangements.
• Works with leadership to identify and problemsolve provider contracting issues.

15% Administrative Support

• Administrative Support Participates in a missiondriven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short and longterm goals/priorities for the department.
• Develops desktop procedures network overviews and identifies network nuances that improve processes and workflows.
• Participates in a missiondriven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
• Assists the teams in carrying out department responsibilities and collaborates with others to support short and longterm goals/priorities for the department.
• Develops desktop procedures network overviews and identifies network nuances that improve processes and workflows.

5% Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelors degree PLUS 4 years of experience with provider contracting negotiation hospital and delegated health network/medical group provider agreements or other complex provider contracts required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Experience with MediCal and Medicare lines of business within a health plan or large health care delivery system required.
• Experience with MediCal Medicare feeforservice reimbursement rates and capitation methodologies required.

Preferred Qualifications:

• 4 years of contracting and network management experience in California with a health plan or large provider delivery system.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Healths leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize be analytical problemsolve and possess project management skills.
• Work in a fastpaced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multiprogram teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g. Microsoft Office: Word Outlook Excel PowerPoint) and job specific applications/systems to produce correspondence charts spreadsheets and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone telephone systems and facetoface interactions.
• Manual dexterity for typing writing standing and reaching flexibility body movement for bending crouching walking kneeling and prolonged sitting.
• Lifting and moving objects patients and/or equipment 10 to 25 pounds

Work Environment:

• If located at the 500 505 Building or a remote work location:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud

V Group Inc. is an IT Services company that supplies IT staffing project management and delivery services in software network help desk and all IT areas. Our primary focus is the public sector including state and federal contracts. We have multiple awards/ contracts with the following states: CA FL GA MD MI NC NY OH OR PA SC VA and WA CT TN. If you are considering applying for a position with V Group or partnering with us on a position please feel free to contact me with any questions you may have regarding our services and the advantages we can offer you as a consultant.


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Job Tags

Contract work, Immediate start, Remote job, Outdoor, Flexible hours, Weekend work, Afternoon shift, Monday to Friday,

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