IPA Contracts Manager

Alignment Health is breaking the mold in conventional health care committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fastgrowing company you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters not only changing lives but saving them. Together.

GENERAL DUTIES/RESPONSIBILITIES:
1. Responsible for the overall performance of the network within a designated region and for assuring that the daytoday operations of the provider network are consistent with standards/ expectations and develops provider education materials as needed to support adherence with company requirements.
2. Negotiates / renegotiates and finalizes all assigned contracts which may be primary care specialist ancillary hospital group/IPA as well as ensure the accuracy of administration of these agreements.
3. Develops agendas and lead regularly scheduled Joint Operations Meetings to drive results including oversight of New Provider Orientations and new Contract Orientations. Ongoing meetings will focus on addressing performance improvement metrics resolving operational issues including but not limited to utilization management financial enrollment member appeals and grievances provider termination/panel closures continuity of care and marketing activities.
4. Executes regional workplans monitors performance metrics updates status and communicates progress both internally and externally to ensure results.
5. Acts as technical resource on provider relations issues and offers strong collaborative leadership internally as well as externally. Responsible for timely and professional interaction with internal and external customers.
6. Interprets company policies and procedures.
7. Ensures accurate and timely data reporting requirements are being met for designated regions including provider network contacts eligibility and capitation reports risk sharing claims timeliness pharmacy utilization bed day utilization encounter data and audit compliance.
8. Develops goals and objectives that align with Network Management Directors performance metrics to ensure department KPIs are met as well as the organizations vision for future growth and network development.
9. Utilizes contracting knowledge for effective problem resolution and compliance. Responsible for timely and professional interaction in response to grievances. Research analyze and resolve complex problems dealing with hospital shared risk pool claims appeals and eligibility issues within the appropriate limits.
10. Manages the activities and development of the Network Management Specialists.
11. Represents the department in interdepartmental meetings and selected committees.
12. Other duties as assigned.

Supervisory Responsibilities:

N/A

Job Requirements:

Experience:

Required: Minimum 5 years experience with an HMO managed care provider organization (IPA Medical Group or institutional provider) or insurance company with at least 3 years specific experience in managed care contracting and knowledge or Medicare Advantage regulatory guidelines.

Preferred: 7 years of experience in field.

Education:

Required: High School Diploma or GED. Bachelors degree or four years additional experience in lieu of education.

Training:

Required:

Preferred:

Specialized Skills:

Required:

• Ability to communicate positively professionally and effectively with others; provide leadership teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members management employees and vendors;
• Language Skills: Ability to read and interpret documents such as contracts safety rules operating and maintenance instructions and procedure manuals. Ability to interpret government regulations a must. Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of providers or employees of internal/external organization.
• Mathematical Skills: Ability to calculate figures and amounts such as fee schedules per diem rates discounts interest commissions proportions and percentages. Ability to apply concepts of algebra geometry and statistics.
• Reasoning Skills: Strong analytic and problemsolving skills required including ability to synthesize interpret and apply detailed and complex information.
• ProblemSolving Skills: Effective problem solving organizational and time management skills and ability to work in a fastpaced environment.

Licensure:

Required: None

Preferred: Valid Drivers license if driving

Other:

Office Hours: MondayFriday 8am to 5pm. Extended work hours as needed.

Maintain reliable means of transportation. If driving must have a valid drivers license and automobile insurance.

Drives approximately 2040 of the time to provider sites.

Anticipated Hiring Range: $95000 $105000

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 While performing the duties of this job the employee is regularly required to talk or hear. The employee regularly is required to stand walk sit use hand to finger handle or feel objects tools or controls; and reach with hands and arms.

2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability age protected veteran status gender identity or sexual orientation.

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