AlhambraRecruiter Since 2001
the smart solution for Alhambra jobs

Senior Director - Contracting and Network Strategy

Company: Networkmedicalmanagement
Location: Alhambra
Posted on: May 25, 2023

Job Description:

Job Title: Senior Director - Contracting and Network StrategyDepartment: Contracting About the Role:We are currently seeking a highly motivated Senior Director - Contracting and Network Strategy. This role will report to the Senior VP - Payer Relations and Contracting and enable us to continue to scale in the healthcare industry. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Alhambra, CA and Monterey Park, CA and at home on a weekly basis.This role will work closely with the SVP of Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for the California Market and other states, and researching and resolving payor and provider issues.What You'll Do:

  • Leads contract negotiations, as assigned. This may include, but is not limited to, capitated health plan agreements and fee-for-service negotiations with HMO's, PPO's, ASC's, UCC's, all types of provider contracts, hospital contracts and ancillary contracts
  • Circulates draft contract terms/language to Legal, Finance and Medical Management teams for review & approval
  • Reviews health plan and provider contract language, and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
  • Provides contract insight to the capitation management team (Health Plan/Provider Analysis), business office and claims shop to ensure accurate and efficient loading of contracts and claims payment
  • Develops, implements, and manages the Division of Financial Responsibility (DOFR) documents for entire California market
  • Answers and/or resolves urgent inquiries from health plans or internal departments in a timely manner
  • Lead a team with direct reportsMinimum qualifications:
    • Master's degree and/or Bachelor's degree or BS/BA in business administration or health care related field of study or equivalent years of experience
    • 6+ years prior experience in contractingYou're great for this role if:
      • Experience in risk-based contracting and associated financial analysis strongly preferred
      • Ability to close deals under tight deadlines-sense of urgency
      • Comfortable in negotiating all types contracts from start to finish within defined parameters
      • Experience with FFS, capitation, and risk sharing arrangements
      • Experience with government programs (Medicare, Medi-Cal, D-SNP)
      • Experience working with health plan, provider and hospital counterparts
      • Knowledge of California payer, Institutional and IPA contracting
      • Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
      • Project management skills/experience
      • Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
      • Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
      • Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
      • Proven ability to work effectively both independently and with teams in a dynamic and fast-paced environment
      • Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
      • Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
      • Experience with healthcare operations, systems, and financial/claims data analysis.Who We Are:ApolloMed (NASDAQ: AMEH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.Our Values:
        • Patients First
        • Empowering the Independent Provider
        • Be Innovative
        • Operate with Integrity & Deliver Excellence
        • Team of OneEnvironmental Job Requirements and Working Conditions:
          • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1668 S Garfield Avenue, Alhambra, CA 91801and 1600 Corporate Center Dr. Monterey Park, CA 91754.
          • The total compensation target pay range is between $175,000 - $190,000. This salary range represents our national target range for this role.ApolloMed is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at to request an accommodation.Additional Information:The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Keywords: Networkmedicalmanagement, Alhambra , Senior Director - Contracting and Network Strategy, Executive , Alhambra, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Alhambra RSS job feeds