Contracts Manager

Position Summary/Position

Under the direction of the Director of Provider Contracting and/or the Provider Contracting Manager, the Contracts Manager is responsible for the management and maintenance of the entire provider network (Primary Care Services, Specialty Services and Ancillary Services) including but not limited to negotiation of contract rates and terms, timely renewal of all contracts to ensure continued network participation, initial processing of all credentialing applications for all new providers, communication with providers to address and assist with additional needs including managing all requests for rates increases; Physician recruitment to identify new leads to increase network access and meet network adequacy as per regulatory requirements. Research and follow up on all internal emails sent to the Contracting Department requesting contract/provider information; Supporting the Director of Provider Contracting and Provider Contracting Managers in all required or directed activities.

Major Functions (Duties and Responsibilities)

1.   Develop and negotiate Provider agreements.

2.  Recruit and maintain a network of required/requested providers in an assigned geographic region. The network will include: primary care, specialty care, ancillary, hospitals and other health plan providers.

3.   Participate as directed by the Director of Provider Contracting and/or the Manager with Network Development.

4.  Participate in developing various payment methodologies and analyzing rate proposals for providers. Requires the ability to perform and monitor on-going  financial  analysis  of contract performance.

5.   Work with assigned support staff to ensure contract inflow and outflow is being maintained.

6.   Assist in the preparation, coordination and analysis of all Request For Proposals (RFP) for the Department.

7.   Assist the Provider Services Department as needed.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Three (3) years of experience in a Managed Care environment, emphasis on Provider contracting. A minimum of two (2) years of direct experience in Provider contracts.

Preferred Experience

Experience in negotiating Provider contracts preferred, but not required.

Education Qualifications

Bachelor’s degree from an accredited institution required. 

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Thorough knowledge of contracting structures and payment methodologies preferred.

Skills Requirement

Provider contracting and  analytical  skills  with emphasis  on time management, financial analysis, and problem solving. Microcomputer applications (Microsoft Word and Excel required) for use in all aspects of an office environment. Excellent communication, interpersonal and organizational skills.

Abilities Requirement

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

A valid California Drivers License required.

Word processing, spreadsheet and database analysis involving computer keyboard and screens, automobile travel within the Inland Empire.

Work Model Location

Physical Requirements