Region Manager Contracts Payer Strategy - California

Region Manager Contracts Payer Strategy - California

The posted compensation range of $40.66 - $58.96 / hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

The Region Contract Manager for Payer Strategy & Relationships (PSR) assists PSR leaders in the development, implementation and management of PSR system standards for contracting and payer relations. Accountabilities include : ensuring that managed care contracts are correctly negotiated and implemented for operational compliance across the division; implementing departmental policies and procedures that focus on maintaining positive working relationships with Payers and Providers; coordinating directly with internal & external stakeholders to ensure contract compliance on a regional and market level.

Essential Key Job Responsibilities :

• Negotiates contracts with Payers on behalf of Providers with a focus on physicians and mid-level professionals and with Providers on behalf of capitated physicians. Contracts may include letters of agreement and single case agreements at the direction of senior leadership.
• Maintains supportive relationships with key departments that support the division in order to quickly resolve contract-related issues.
• Ensures complex payer information and reports are analyzed and summarized to provide timely operational and contracting recommendations for key internal leaders. Research contract and regulations to assist with claim payment issues and / or credentialing issues with payers.
• Drafts and summarizes content for official correspondence as issues arise with policy updates or compliance with agreements.
• Assists with updating project plan documents and communications plans.
• Monitors contract terms, termination dates, and rate update deadlines to assure proper and timely notification is achieved in compliance with project plan and strategy.
• Assists in developing tools / updates for communicating and operationalizing contract terms, amendments, and policy terms.
• Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital, physician, and ancillary services.
• As applicable, ensure standardized monthly, quarterly and ad-hoc meetings with Managed Care Organizations occur and issues are resolved in a timely fashion.
• Participate in joint operating committee meetings with payers, medical groups or providers as needed

Qualifications :

Minimum Qualifications :

Required Licensure and Certifications :

Required Knowledge, Skills and Abilities :

Overview :

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.