Provider Relations and Contracting Manager; Iowa

POSITION PURPOSE

Health Partners is hiring a Manager of Provider Relations and Contracting.

Manage Health Partners strategic relationships with providers including: provider contracting, financial analysis, operations management, development of strategic partnerships and coordination with Health Partners and Contracted Medical Groups. Overall responsibilities include:

Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.

Establish and maintain positive contractual and strategic relationships between Health Partners and its network of providers.

Develop and implement network contracting strategies consistent with Health Partners overall objectives.

Develop and implement sound reimbursement methodology for providers.

Negotiate contract terms with providers

Work with government programs management to ensure compliance with Medicare product requirements and regulations.

Create product specific networks as directed by Health Partners indicatives.

Coordinate communications between the Health Plan, primary care, specialty and institutional providers.

Manage the day-to-day operational needs related to providers.

Supervise and mentor direct reports, including service specialists and contract consultants when applicable.

Perform project management duties for a variety of projects designed to enhance strategic contracted partnerships and services for the Health Plan, contracted clinic systems, Health Partners Medical Group and Regions Hospital.

Investigate, mediate and resolve inquiries regarding the delivery of care by providers.

Provide support to the Quality Utilization Management Department in analyzing provider trends and developing action plans to effect change

Independently manage and supervise the administrative functions relating to the contracted providers, including network strategy development, financial analysis, negotiations, contract drafting, contract monitoring, establishing provider relations and communications.

Independently manage and supervise the implementation of provider contracts. Develop systems, policies and procedures to communicate and ensure the successful implementation of contracts by the following internal departments:
Claims, Accounts Payable, Member Services, Clinic Operations, Support Services, Quality Utilization Management, Referral Secretaries, Government Service, Pharmacy Care Network, Sales and Marketing, and Contracting.

Independently manage and supervise contract maintenance and contract filing functions. Develop and maintain systems and procedures to ensure the collection of credentialing information. Ensure the contents and filing of contracts and amendments are in accordance with the Minnesota Department of Health, government programs, accreditation and other regulatory agency requirements. Ensure the maintenance of current provider listings for internal uses and to ensure that contracts are current and up to date with all necessary or required contract provisions.

Monitor contract compliance and adherence to contract provisions by providers and Health Partners. Monitor the payment of claims by Health Partners to ensure the correct application of contract payment terms. Take corrective action with providers who are not complying with contract terms, or with Health Partners departments not adhering to contract agreements. Participate in year end contact settlement process, where appropriate.

Develop and implement appropriate reimbursement methodologies such as capitation, case rates, fee schedules, per diems, Ambulatory Patient Classifications and Diagnostic Related Groups.

Monitor, analyze and interpret financial and utilization patterns of providers. Implement corrective action steps as necessary.

Manage the operational, financial and administrative relationships with providers. Provide support to the Medical Director, Associate Medical Directors and Department Heads to coordinate communications and operations.

Participate in annual planning exercise…