This position is responsible for providing strategic direction on Contracting and Network Development for all MCMF entities including Greater Newport Physicians, MCMF Contracted Specialists; MCMF Specialist agreements with IPA’s or other provider groups; UCI Health IPA; UCI Health MSO when requested; Edinger Medical Group and any new entities when brought into the Medical Foundation. This position is responsible for overall Contract Administration including Maintenance and a Contract Management System effectively manage contracts including renewals processing and renegotiations and any ACO Contract Maintenance in support of ACO department. This position is also accountable for monitoring network adequacy of necessary specialties and ensuring access to necessary medical specialties including tertiary services.
Principal Duties and Responsibilities:
Responsible for the strategic planning and management of MCMF’s contract negotiations, documentation and relationship management. Advises and provides guidance to other emerging Memorial markets on contracting standards, which may include contract template review and input to senior management on recommended strategies, as well as involvement in specific negotiations and documentation.
Collaborates with other departments to develop assessment and communication tools to monitor performance of the agreements and other information critical to the organization and oversee the review, negotiation, implementation and maintenance of capitation and fee for service contracts and related materials consistent with organization’s strategic goals, business and marketing plans.
Directs the contracting staff. Manage the day-to-day productivity of the department and provide leadership to the staff.
Oversees or provides direction on analysis of performance of provider contracts and collaborates with executive management on opportunities for lowering the cost of providing medical services using contractual relationships.
Keeps informed on new provider compensation strategies or methodologies such as capitation, bundled payments, and pay for performance opportunities or other means of compensation incentives to engage providers with MemorialCare strategies.
Collaborate with management and staff from other departments to develop processes, resolve issues and further the business goals of the company.
Collaborates with IT on contract maintenance issues ensuring fee schedules are updated in conformance with contract requirements including consulting with MC IT Tapestry experts on implementation of new contractual terms.
Advise senior management on provider network strategies (develops, executes and maintains) to meet the needs and goals of physician groups and Hospitals.
Lead or oversee the negotiation and renegotiation of provider contracts and letters of agreement.
Ensure data integrity in the EPIC managed care system in regard to provider pricing and provider demographics.
Oversee provider inquires as it relates to contract/claims issues and works with providers and office staff to ensure claims are paid according to contractual terms.
Works in concert with medical management and marketing to develop strategies to meet market growth and medical cost targets.
Works with Provider Relations in on-boarding network physicians/providers and supports department in addressing contract questions.
Minimum of 5 years’ experience in management role(s).
Contract knowledge on different types of physicians compensation other than an employed model
Knowledge of Provider Capitation for contracting and specialty provider contracting
Good Negotiation skills
Bachelor degree in Business Administration, Health Care Administration or related field. Master’s degree preferred.