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Director Contracting Job
Date: Nov 21, 2009
Location: Baltimore, MD, US
Job Title:
Director Contracting
Job ID:
10364
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
Responsible for the management of all aspects related to Hospital Contracting functions or for the development, implementation, and maintenance of the hospital relations program at the Health Plan or for developing and expanding physician, physician groups, IPAs, and ancillary networks. Responsibilities may include coordinating all provider network related activities in conjunction with the appropriate home office and local health plan staff. The individual may also be responsible for the development and implementation of all Provider Agreements to meet AMERIGROUP's goals and objectives as well as negotiating contracts with providers statewide under favorable terms and conditions upon notice by provider or strategic initiative of health plan. The Director Contracting, in collaboration with AVP of Provider Relations or AVP Contracting, will strategically develop the provider network for the health plan
PRIMARY RESPONSIBILITIES:
Hospital Contracting/Services
1. Identify and negotiate contracts with Hospitals on a statewide basis in order to fill gaps or meet departmental goals and objectives. Develop and over see the management and growth of the hospital relations program. Conduct appropriate marketing research analysis in order to identify and establish strategic relationships with hospitals throughout the state.
2. Analyze past payment and utilization data in order to renegotiate financially viable contracts with those facilities with high volume utilization. Make recommendations to achieve medical cost savings for the company.
3. Oversee and coordinate with various departments to effectively manage hospital relations strategy.
4. Prepare financial Analysis Reports by Hospital by line of business in order to better identify reimbursement structures that will ensure financial stability and viability as required by the Plan.
5. Conduct appropriate marketing research analysis in order to identify and establish strategic relationships with Hospitals throughout the state.
6. Responsible for leading and managing all aspects of provider implementation. This includes understanding and communicating unique arrangements and ensuring the organization accurately administers those arrangements.
7. Serve as key contact for targeted hospitals to ensure effective communication and response mechanisms.
8. Other duties as requested or assigned.
Network Development:
1. Analyzes provider network for adequacy and assists in the identification of hospitals and key
provider groups wherever network gaps an/or needs appear.
2. Negotiates and re-negotiates hospital, IPA, PHO, and physician group contracts within
company's established MER goals.
3. Negotiate risk, medical savings model contracts and others as appropriate
4. Establishes appropriate and competitive reimbursement rates in conjunction with Medical
Economics
EDUCATION AND EXPERIENCE:
EDUCATION AND EXPERIENCE:
Education
Required:
· Bachelor's degree or equivalent experience in healthcare or business administration
Preferred:
·
Years and Type of Experience Required:
Required:
· 7 years' experience in a managed healthcare or hospital environment, provider relations or network management with at least 3 years of leadership/management experience.
Preferred:
·
Specific Technical Skills
Required:
· Good understanding of various types of provider contracts and reimbursement models
Preferred:
·
Certifications or Licensures
Required:
· Must have a valid driver's license and access to a motor vehicle
Preferred:
·
Other:
Required:
· Knowledge of provider compensation and capitation issues.
· Familiarity with provider organizational arrangements; IPA, PHO, Group Practice, etc
· Excellent negotiation skills.
· Excellent communications and presentations skills.
· Strong analytical abilities.
· Ability to complete multiple projects and to meet deadlines.
· Travel Required.
· Appreciation of cultural diversity and sensitivity towards target population.
Preferred:
·
SCOPE INFORMATION
# Direct Reports: Varies by Plan size
# Indirect Reports:
Budgetary $ Responsibility:
PHYSICAL REQUIREMENTS
· Must be able to operate a computer.
· Must be able to operate a telephone.
· Must be able to travel on common carrier and adhere to AMERIGROUP's travel policies
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Director Contracting
Job ID:
10364
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
Responsible for the management of all aspects related to Hospital Contracting functions or for the development, implementation, and maintenance of the hospital relations program at the Health Plan or for developing and expanding physician, physician groups, IPAs, and ancillary networks. Responsibilities may include coordinating all provider network related activities in conjunction with the appropriate home office and local health plan staff. The individual may also be responsible for the development and implementation of all Provider Agreements to meet AMERIGROUP's goals and objectives as well as negotiating contracts with providers statewide under favorable terms and conditions upon notice by provider or strategic initiative of health plan. The Director Contracting, in collaboration with AVP of Provider Relations or AVP Contracting, will strategically develop the provider network for the health plan
PRIMARY RESPONSIBILITIES:
Hospital Contracting/Services
1. Identify and negotiate contracts with Hospitals on a statewide basis in order to fill gaps or meet departmental goals and objectives. Develop and over see the management and growth of the hospital relations program. Conduct appropriate marketing research analysis in order to identify and establish strategic relationships with hospitals throughout the state.
2. Analyze past payment and utilization data in order to renegotiate financially viable contracts with those facilities with high volume utilization. Make recommendations to achieve medical cost savings for the company.
3. Oversee and coordinate with various departments to effectively manage hospital relations strategy.
4. Prepare financial Analysis Reports by Hospital by line of business in order to better identify reimbursement structures that will ensure financial stability and viability as required by the Plan.
5. Conduct appropriate marketing research analysis in order to identify and establish strategic relationships with Hospitals throughout the state.
6. Responsible for leading and managing all aspects of provider implementation. This includes understanding and communicating unique arrangements and ensuring the organization accurately administers those arrangements.
7. Serve as key contact for targeted hospitals to ensure effective communication and response mechanisms.
8. Other duties as requested or assigned.
Network Development:
1. Analyzes provider network for adequacy and assists in the identification of hospitals and key
provider groups wherever network gaps an/or needs appear.
2. Negotiates and re-negotiates hospital, IPA, PHO, and physician group contracts within
company's established MER goals.
3. Negotiate risk, medical savings model contracts and others as appropriate
4. Establishes appropriate and competitive reimbursement rates in conjunction with Medical
Economics
EDUCATION AND EXPERIENCE:
EDUCATION AND EXPERIENCE:
Education
Required:
· Bachelor's degree or equivalent experience in healthcare or business administration
Preferred:
·
Years and Type of Experience Required:
Required:
· 7 years' experience in a managed healthcare or hospital environment, provider relations or network management with at least 3 years of leadership/management experience.
Preferred:
·
Specific Technical Skills
Required:
· Good understanding of various types of provider contracts and reimbursement models
Preferred:
·
Certifications or Licensures
Required:
· Must have a valid driver's license and access to a motor vehicle
Preferred:
·
Other:
Required:
· Knowledge of provider compensation and capitation issues.
· Familiarity with provider organizational arrangements; IPA, PHO, Group Practice, etc
· Excellent negotiation skills.
· Excellent communications and presentations skills.
· Strong analytical abilities.
· Ability to complete multiple projects and to meet deadlines.
· Travel Required.
· Appreciation of cultural diversity and sensitivity towards target population.
Preferred:
·
SCOPE INFORMATION
# Direct Reports: Varies by Plan size
# Indirect Reports:
Budgetary $ Responsibility:
PHYSICAL REQUIREMENTS
· Must be able to operate a computer.
· Must be able to operate a telephone.
· Must be able to travel on common carrier and adhere to AMERIGROUP's travel policies
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Nearest Major Market: Baltimore
Job Segments: Management, Manager
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