Contracting Excellence & Managed Care Director
Cambia Health Solutions

Job Info

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Contracting Excellence & Managed Care Director

Washington, Oregon, Utah or Idaho

The Contracting Excellence and Managed Care Director plays a key role in the overall management and success of the Network Market team by building agile Network Management Contracting infrastructure and processes. The Contracting Excellence and Managed Care Director is accountable for enhancing contracting processes and infrastructure to enable wholistic contract design that encompasses fee for service and alternative payment model arrangements. They will ensure proper governance of provider contracting by clarifying and defining contracting processes and procedures and ensuring they are executed with rigor.

General Functions and Outcomes

• Lead the development of strategies for provider contracting and managed care.
• Responsible for aligning divisional leadership to execute on industry best standards in all aspects of provider contracting - developing a framework and structure for contracting that takes into consideration delivery, risk management, people development, financial/budget stewardship, and continuous improvement.
• Ensure that processes, policies, and procedures are clearly articulated and administered.
• Support Market Vice Presidents in negotiations that ensure a best-in-class unit cost contracting trends while enabling the transition to alternative payment models, ensuring that the appropriate contract terms meet business and regulatory requirements.
• Define, develop, and deploy a roadmap of new solutions to support provider transformation in the market.
• Supports and provides direction on network analytics required for network management, including analyzing competitor and transparency data.
• Works across all departments to create and implement strategies to meet corporate objectives.
• Develop framework and construct of managed care and capitation contracts at established per member per month targets

Minimum Requirements

• Proven ability to solve for multiple internal and external stakeholders and work across highly matrixed organizations. Executive presence, leadership and influence skills, and experience collaborating with complex organizations to improve their operating and strategic position.
• Ability to identify, champion and drive process improvement changes across multiple functional areas. Strong influence, communication, and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders.
• Proven business acumen including understanding of market dynamics, financial/budget management, data analysis with expertise in applying data and best practices to inform decision making.
• Demonstrated ability for creative strategies to accomplish objectives, plan and execute complex integrated delivery of products, projects and programs, and drive results across internal teams and/or external business partners.
• Proven ability to analyze, develop and manage complex processes and lead change across a variety of stakeholders to deliver results with multiple deadlines and shifting priorities.
• Demonstrated ability to lead high performing teams.
• Strong decision making, complex problem solving, critical thinking, and coordination skills.
• Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.
• Displayed ability to adapt and be successful in a growth-oriented organization.
• Minimum of 15 years contracting and negotiating experience involving complex delivery systems and organizations required to include risk and capitation contracts.
• Medicare Advantage contracting experience, including shared savings/risk and alternative payment model arrangements required.
• Displayed ability to adapt and be successful in a growth-oriented organization.

Normally to be proficient in the competencies listed above:

The incumbent would have a Master's Degree in Business or Health Care Administration and 15 or more years of contracting and negotiating experience involving complex delivery systems, with at least 15 years' experience establishing frameworks and governance processes for provider contracting.

Work Environment

Work primarily performed in an office or home office environment Travel required, locally or out of state.

The base pay annual salary range for this job is $134,000-$218,500 with an annual bonus.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off and company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.