Contracting Manager - Provider Services - Managed Care

Summary/Position Objectives: 

Responsible for managing the assigned activities of the Provider Services department, including provider data integrity. Functions as liaison with other departments to expedite business operations, assists in organizational audits and maintains provider manual, directory, and contract files to ensure compliance with AHCCCS, HCGA, and NCQA.  Responsible for maintaining and managing the assigned day to day operations of the Provider Services department including oversight of Provider Services Representatives and contract file specialist.

 

Responsibilities:  Essential Functions: 

?  Manages the activities of Provider Services employees including ancillary and ALTCS provider education, problem resolution, recruiting, service monitoring and contracting activities. 

?  Responsible for participating in organizational audits to ensure organizational compliance with regulatory agencies (AHCCCS, HCGA, and NCQA).

?  Monitors and audits components of subcontracted health plans to ensure compliance with state and national regulations.

?  Manages activities related to the preparation of provider manual, provider notification materials and contributes to Provider Newsletters.

?  Develops provider education materials for quarterly visits and structures provider visit format and monitoring activities. Assists with the development and implementation of methods to measure provider performance, compliance and satisfaction based upon objective criteria.

?  Manages and develops the skills of department personnel.  Monitors and assesses personnel performance on an ongoing basis.  Responsibilities include selection training, oversight and periodic evaluation of Provider Services personnel.

?  Responsible for ensuring network adequacy and cost effectiveness in accordance with established minimum standards.  Negotiates contracts with new providers and issues RFP?s as necessary for key accounts.

?  Intervenes directly with providers as necessary to resolve issues, expand the network, and maintain participation of key providers.

?  Manages and monitors the functions of the provider representatives to ensure provider file integrity for Provider Services reporting requirements.  Oversees correction of discrepancies in provider participation data.

?  Develops, writes, updates and maintains departmental policies and procedures.

?  Develops and maintains the MCP contract templates including securing all required approvals.

?  Performs other duties, assignments and responsibilities as assigned or required. 

 Secondary Functions: 

?  Management of multiple projects simultaneously.

?  Works in a manner that is not disruptive to peers, supervisors and/or subordinates.

?  Must maintain regular and acceptable attendance at such level as is determined in the employer?s sole discretion.

?  Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.

?  Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)

 

 

 

 

 

 Knowledge and Skills:

Percentages, ratios, addition, subtraction, multiplication and division. Complex decision making responsibility.  Requires application of analytical methods to develop new approaches or alternatives, and considerable judgment is required to select appropriate solution. Strong analytical capability. Must be able to understand and correct moderately complex logical problems. Communicates, writes, advises and counsels on  extremely complex matters. Personal computer skills including various types of software applications.

 Education and Work Experience:

Bachelor?s degree in a business or healthcare related field. Five years experience in managed care, three of which were in a management capacity. Provider service experience preferred.

 

Work Environment Qualifications:

Normal Office Environment. Ability to be mobile. Some travel required.