Manager, Provider Contracting

Position Summary/Position

Under the direction of the Director of Contracting, the Manager, Provider Contracting is responsible for the management of the Contracts Managers, contracting with providers, contract operational issues, management / or coordination of network activities and duties as assigned for IEHP, Health Plan and IEHP-Direct.

Major Functions (Duties and Responsibilities)

1. Manage and train the Contracts Managers including establishing and monitoring performance standards and completing formal evaluations at least annually
2. Communicate with Practitioners providing information, assistance, claims resolution and in-services, as necessary
3. Assist in the review of network coverage and ensure adequate network coverage always exists
4. Interface with key IEHP Chiefs, Legal Counsel, Medical Management, Directors, Managers, Supervisors, etc to resolve issues and establish or refine policies and protocols to ensure network performance
5. Assist in the ongoing monitoring of claims payment, capitation and incentive pool funds to ensure timely and accurate reimbursement to Providers
6. Assist in analyzing utilization, referrals and claims information for trends and review findings with Medical Management
7. Assist in the development of internal and external Policy/ Procedures Manuals including producing up to date IHEP Direct Provider Guide
8. Maintain a positive relationship with Providers and keep open lines of communication with Providers on issues related to IEHP Policies and Procedures
9. Oversee Provider contract performance and identify areas of improvement
10. Assist and support in negotiating cost effective contracts for IEHP, Health Plan and IEHP-Direct
11. Assist in overseeing network reporting requirements to ensure compliance with regulatory agencies
12. Participate in the development of the IEHP Direct budget process and recommend actions to improve performance
13. Assist and support the integrity of the Network Database
14. Assist in the hiring process of the department team
15. Support Intern training/ development
16. Assist and support Hospital contract negotiations
17. Assist and facilitate Hospital JOMs
18. Perform a variety of tasks, lead, direct and delegate work to Contracts Managers and Others

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Directly or indirectly has supervised or managed other team members. Has conducted direct staff training sessions; and has directly overseen or managed special staff related projects.

Preferred Experience

Five years of direct Healthcare experience preferred.

Education Qualifications

Bachelor’s degree from an accredited institution required. 

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Knowledge of claim system processes and analysis. Reimbursement and benefit structure interpretation.

Skills Requirement

Microcomputer applications: spreadsheet, database, and word processing. Must have excellent verbal and written communication 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

Current CA Driver License and automobile insurance coverage required.

Word processing and data entry involving computer keyboard and screens.

Work Model Location

Physical Requirements