Health Plan Contract Manager

Community Bridges Inc•Mesa, AZ

About The Position

The Health Plan Contract Manager is a key contributor whose primary responsibility is contracting healthcare services provided by Community Bridges, Inc. (CBI) with Medicaid, Medicare and Commercial payers, and government entities (e.g. counties, cities, other municipalities). The manager serves as the point of contact for internal inquiries regarding health plan contract needs, implements contracting strategies identified by the Executive Leadership Team (ELT) and works collaboratively with all internal departments to ensure there is awareness and knowledge of contracts and contract requirements. The manager also participates in payer Joint Operations Committee (JOC) meetings and is position is also involved in contracts with Accountable Care Organizations. The administrator works closely with the VP Payer Relations to provide status updates on contracting opportunities, existing contracts that require amendments, and ensure legal review is completed prior to recommending signature. This position is also responsible for establishing the necessary structures for tracking and monitoring contracts through the lifespan to ensure contracts are current.

Requirements

Bachelor’s Degree in Business Administration or Healthcare Management, or a related field required.
Two (2) or more years of leadership experience is required.
Five (5) or more years of experience in contract management/negotiation of healthcare contracts (Behavioral Health, Addiction, Integrated Care) in multiple settings (e.g. outpatient, facility, physician/provider, etc.) required.
Experience with rate setting and analysis required.
Working knowledge in key healthcare operations (e.g., claims/billing, coding, credentialing required.
AHCCCS Health plan contracting experience strongly preferred.
Knowledge of healthcare industry – statutes and regulations in Medicaid, Medicare, and Commercial systems; knowledge of behavioral health, addiction and physical health services strongly preferred.

Nice To Haves

Master’s in Business Administration or Public Administration preferred.
Three (3) or more years of experience with rate setting and analysis preferred.
Knowledge of multiple reimbursement strategies: FFS, Pay for Performance, Full Risk strongly preferred.
Knowledge of ACOs and contracting with ACOs strongly preferred.
Commercial Health plan contracting experience and building relationships preferred.
Accountable Care Organization experience preferred.
Multi-state healthcare payer strategy or contracting experience preferred.

Responsibilities

Contracting healthcare services with Medicaid, Medicare and Commercial payers, and government entities
Serving as the point of contact for internal inquiries regarding health plan contract needs
Implementing contracting strategies identified by the Executive Leadership Team (ELT)
Collaborating with all internal departments to ensure there is awareness and knowledge of contracts and contract requirements
Participating in payer Joint Operations Committee (JOC) meetings
Involvement in contracts with Accountable Care Organizations
Working closely with the VP Payer Relations to provide status updates on contracting opportunities and existing contracts
Ensuring legal review is completed prior to recommending signature
Establishing the necessary structures for tracking and monitoring contracts through the lifespan to ensure contracts are current