Managed Care Contract Manager V NW Region

Managed Care Contract Manager V
** Must be based in the NW Region

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In addition to the responsibilities listed below, this position is also responsible for drafting and/or consulting with the legal team on complex contract templates and language; responding to inquiries about complex contract templates and language; researching, comparing, and advising on contract rates and services; developing rate methodology and strategies; collaborating with various services lines to implement rate/contract strategies to improve access and availability and service delivery expansion;

interpreting and translating contract terms for senior stakeholders; acting as a role model for the negotiation and completion of companion agreements, letters of intent, and/or memoranda of understanding; and monitoring provider programs in Pay for Performance Agreements, Pay for Quality Agreements, Value Based Purchasing Contracts, and Total Cost of Care.

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross‑functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members.
• Conducts or oversees business‑specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high‑priority issues or risks, as appropriate; monitors progress and results.
• Supports continuous improvement efforts by leveraging innovative and data‑driven approaches to identify and/or consult on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); driving the implementation of process improvement initiatives to aid providers and business goals; collaborating with internal and external partners to develop network strategies and implement improved access to care.
• Ensures contract commitments are met by validating, maintaining, and/or conducting statistical analyses on provider and contract data of the day‑to‑day operation and management of services to identify trends and consult on provider compliance; documenting and reporting provider activities and/or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions.
• Supports contract strategy development by developing, proposing, and implementing short‑term strategies that improve access to patient care while managing outside service costs; providing in‑depth and advanced consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies.
• Grows the Provider Network by reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings using advanced knowledge of current service gaps; developing, maintaining, and managing trusted partnerships with providers to understand their unique service request needs and challenges.; serving as a liaison between providers and KP by coordinating communication efforts (e.g., contract compliance such as access, availability, referral operations, or supporting member complaints);
  
  and supporting provider site visits, daily interactions, and ad hoc meetings.
• Contributes to provider satisfaction by leveraging specialized knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, directories, and other operational issues; leveraging innovative solutions to ensure requests for information, questions,…