Director, Provider Contracting

Date: Apr 29, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7225 

 

Position Summary/Position

 

Responsible for the day to day operations of the Provider Contracts unit. In this capacity, the Director, Provider Contracting will ensure that the IEHP provider network fulfills the triple aim of improving the patient experience and health outcomes in a cost efficient manner.

Major Functions (Duties and Responsibilities)


1. Plan, implement and manage contracting strategies to ensure development of contracted providers to support existing and future product lines.

2. Develop and analyze all provider contract rates to ensure budget objectives are met.

3. Oversee the negotiations for Letter of Agreements and administer the Agreements.

4. Negotiate Provider contracts for the provision of all covered benefits including physicians, behavioral health, ancillaries, IPA’s and hospital agreements.

5. Oversight responsibility for the Contract Administration unit including contract development, processing and maintenance of the Agreement.

6. Oversee the orientation and maintenance of ancillary and facility contracts by conducting hospital JOM’s and in-servicing providers as necessary to fully serve IEHP members as contractually required. Additionally, assist in claims reconciliation issues between the Claims Department and contracted providers.

7.  Work closely with the IEHP Legal Department to ensure compliance with regulatory agencies, IEHP Policies and Procedures and IEHP legal requirements.

8. Collaborate inter-departmentally to ensure contracts are implemented effectively throughout the health plan including Provider Services, Claims and Medical Services.
9. Participate and implement LEAN processes throughout the Provider Contracting Department to eliminate waste and create operational efficiencies.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

7-10 years of managed care experience, emphasis on contracting with a minimum of 5 years of direct experience in analyzing and negotiating contracts. Prior supervisory and project management experience required. Experienced in performing financial and/or statistical analysis.

Preferred Experience

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Preferred Education

 

Master’s degree from an accredited institution preferred.

Professional Certification

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Knowledge of network development. Thorough knowledge of contracting structures and payment methodologies.

Skills Requirement

 

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

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

 

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

Work Model Location

Physical Requirements

 

Starting Salary: $153,670.40  - $195,936.00  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles