Contract Manager
Mid-Atlantic Permanente Medical Group

Job Info

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Who We Are:

The Mid-Atlantic Permanente Medical Group, (MAPMG) is one of the nation's premier multispecialty medical groups and is the largest integrated medical group in Maryland, Virginia and the District of Columbia. Founded in 1980, the medical group has more than 1,700 Permanente physicians spanning more than 50 subspecialties. Together, we serve approximately 800,000 Kaiser Permanente members in Maryland, Virginia, and the District of Columbia at 34 area medical centers, plus several community hospitals and skilled nursing facilities.

Basic Functions:

MAPMG is seeking a Contract Manager to support compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non­compliance, and adhering to the applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures. In addition, regional leaders are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments. To be considered for this opportunity, candidates must reside in Washington DC, Maryland, or Virginia or be willing to relocate. This position offer a hybrid work arrangement that is primarily remote with the ability to go into the office on an as-needed basis

Responsibilities:

• Maintain a high-quality, cost-effective provider network consistent with the strategy of the service area and the region through negotiating cost-effective, compliant contracts able to be administered by KPMAS’ systems.
• Accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Promise, and specific departmental/organizational initiatives.
• Consistently demonstrate the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers, and vendors.
• Responsible for interfacing with MAPMG and MSBD to ensure regional strategies, geographic expansion, member satisfaction and product deployments are adequately supported by the provider network.
• Successfully negotiate contracts that achieve cost reduction or other contract and relationship maximization. This includes facilities, individual and group practices, using a diverse range of techniques and contracting "best practices", to include DRGS, per diems, case rates, and other industry standard payment methodologies.
• Negotiate agreements with hospitals and physician and ancillary providers, including high volume groups, in a manner consistent with market strategy utilizing approved contract templates, approved reimbursement methodologies, KP standards, and applicable regulations.
• Monitor contract performance.
• Work closely with analytics, finance, marketing, claims, UM, member services, membership administration, benefits administration, and medical group leadership to implement contracting options on time and within budget.
• Work with Provider Relations to assure smooth transition from contracting to service activities.
• Develop and quantify strategic options for network development and expansion including, but not limited to:
  • Identifying contract options
  • Establishing short- and long-range contractual terms
  • Developing pricing models across multiple facilities, service lines, service levels and programs
  • Maximizing contract leverage
  • Preparing reports on the cost of contracted services; and
  • Identifying trends and then using a team-based approach to evaluate options for change
• Work with Legal and Compliance to assure that contract templates are compliant
• Ensure that contracts can be administered within KPMAS systems
• Meet all regulations related to their sphere of contracting
• Coordinate with Practitioner and Provider Quality Assurance (PPQA) to ensure timely credentialing of all providers prior to contract being effective.
• Coordinate with analysts to develop analyses that will result in cost effective contracts
• Coordinate with Provider Configuration to assure that all contracts are loaded accurately and in a timely manner and to avoid negative impact on claims performance due to retro contracts or inaccurate configuration.

Qualifications:

• Bachelor's Degree preferred.
• Master’s Degree preferred.
• Seven years progressive responsibility and quantifiable results in network development and delivery system negotiations.
• Hospital, physician, and ancillary provider reimbursement methods for commercial and government payers.
• Five years’ experience contracting for multiple managed care products including HMO, PPO, POS, EPO, CDHP and multiple funding options including fully insured and self-funded plans.
• Knowledge of network development, provider network operations, provider relationship management, reimbursement analysis, contract performance analysis required.
• General knowledge of legislative and government activities and marketplace issues affecting the region preferred.
• Comprehensive knowledge of Medicare payment methodologies, level of care pricing, and federal and state health care regulations.
• Excellent public presentation, negotiation, stakeholder facilitation, time management,
  problem solving, analytical, organizational, written, and verbal skills are essential.
• Software skills including Microsoft Word, Excel, Power Point, Access, Project, and Visio preferred.

Competitive Benefits:

We are proud to offer a comprehensive benefits package that is designed to support our employees and their families’ health and wellbeing. We offer competitive compensation and benefits designed to help our employees stay healthy and thrive in and beyond the workplace.

• Competitive compensation package
• 100% employer-funded medical and dental insurance premiums for employees and families
• Great work/life balance
• Generous paid time off, including vacation, holidays, and sick leave
• Maternity and parental leave
• Pension plan, and 401(k) retirement plan with employer contributions
• Life insurance, and short-term disability and long-term disability coverage
• Education reimbursement
• Wellness programs and resources to help you maintain a healthy lifestyle
• Employee Assistance Program

Equity, Inclusion, and Diversity:

At MAPMG, equity, inclusion, and diversity are at the core of our organizational culture. MAPMG is proud to be an equal opportunity employer and is committed to providing equal opportunity for all employees and applicants. We continuously work to identify and mitigate healthcare inequities, and that starts with providing an inclusive, supportive environment for our employees. We encourage applicants of any race, color, religion, sex, sexual orientation, gender identity, or national origin who value diversity and will commit to practicing culturally competent healthcare to apply.

This job has expired.