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Responsibilities

***This position is remote, but will be expected to work PST business hours.

Position Summary:

The Manager, Network Strategy and Contracting reports to the Director of Provider Contracting. Key areas of oversight include negotiation of physician and ancillary provider agreements, oversee the implementation of all contracts including health plan agreements, and provide support to administration in evaluating contract terms and preparing contract proposals. The position supervises the direct contracting team and is responsible for organizing contract information and ensuring that timely information is provided to all departments and partnering stakeholders involved in implementing contract changes.

Responsibilities may include:

- Negotiate ancillary and provider agreements for DHMSO and contracting providers and clients.

- Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues. Identifies necessity for additional escalation and communicates issues effectively to senior leadership.

- Analyzes network performance, including cost, quality, and utilization data to identify trends, opportunities, and areas for improvement.

- Conducts in-depth data analysis: Analyzing large healthcare datasets to identify patterns, trends, and insights related to contract performance and network effectiveness.

- Create and manage Health Plan Matrix (HP Matrix) which summarizes payor arrangements and contract structures for operational clarity.

- Collaborate with market leadership, finance, claims, and network teams to align contracting strategy with growth objectives.

- Support and partner with system level payor strategy relationships in health plan negotiations.

- Coordinate the implementation of contracts including review of fee sets, division of financial responsibilities, and provider information.

- Partner with Claims and Configuration teams to audit system inputs, reducing payment errors and improving contract load accuracy.

- Develop and own weekly KPIs and dashboards used by executive leadership to assess performance, network adequacy, network performance and market growth opportunities.

- Coordinate agendas for contracting meetings with operational essential staff and partnering stakeholders to review contracting initiatives and current contract inventory.

- Serve as a resource for all necessary areas that collaborate with the contracting department (i.e., Claims, Utilization Management/Authorizations, Benefits, and Finance) to provide contract interpretation, clarification, or modification as required.

- Serve as a resource for all external clients (i.e., Physician Office Staff, Ancillary Provider Contracting Representatives, and Health Plans) that provides contract interpretation, clarification, or modification as required.

- Provide initial review of provider proposals and provide recommendations to Administration for response

- Evaluates, reviews and escalates proposed payment methodologies as requested by providers.

- Provide support to Administration in preparing internal and external correspondence documenting new contracts, contract amendments, and contract terminations.

- Oversees administrative functions such as contract databases ensuring files are organized and information is readily available for review and research

- Negotiate all letters of agreement required for care coordination with non-network providers.

- Attends required meetings and participates in development activities, keeping informed of current trends and changes in your specialty market.

- Responsible for maintaining confidentiality at all times in respects to the sensitive nature of contracts and physician information

- Provide direction and support for ensuring successful execution of contract compliance with PHP policy as well as compliance with applicable Medicare, Medicaid and other third party guidelines.

Qualifications

Minimum Qualifications:

- 5 years experience in contracting, managing service agreements, or providing paralegal services required.

- Minimum of 2 years of Network analysis and strategy experience.

- Bachelors degree or 5 years of related job or industry related experience in lieu of degree

- Must have demonstrated ability to work with word processing, spreadsheet, and database applications with experience in Google Workspace or similar software

Preferred Qualifications:

- Masters degree preferred.

- 5 years experience with background in a managed care facility, IPA or health plan preferred.

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

Pay Range

$40.66 - $58.96 /hour

We are an equal opportunity/affirmative action employer.