Contract Manager IV - Provider Services

Contract Manager IV - Provider Services

Work location is on-site with the flexibility to work remotely, the primary location will be in-office for meetings, per Kaiser Permanente's Authorized States Policy - Employees may be required to travel to a Kaiser Permanente or customer site. Residency is required in the primary location state 9 Piedmont Center, 3495 Piedmont Rd., NE, Atlanta, Georgia 30305.

Job Summary :

In addition to the responsibilities listed below, this position is also responsible for drafting and / or consulting with the legal team on standard contract templates and language; responding to inquiries about standard contract templates and language; researching, comparing, and summarizing contract rates and services; assisting in the development of rate methodology and strategies; participating in the collaboration with various services lines to implement rate / contract strategies to improve access and availability and service delivery expansion; interpreting and translating contract terms for internal and external stakeholders; negotiating and completing letters of agreement; and completing tasks to monitor provider programs in Pay for Performance Agreements, Pay for Quality Agreements, Value Based Purchasing Contracts, and Total Cost of Care.

Essential Responsibilities :

• Promotes learning in others by proactively providing and / or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional / external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and / or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Supports continuous improvement efforts by : utilizing provider, claims, and contracting data to identify and / or consult on continuous improvement 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); implementing process improvement initiatives to aid providers and business goals; participating in collaborations with internal and external partners to develop network strategies and implement improved access to care; and may also include conducting and / or collaborating on advanced modeling and analyses of provider and market data to develop recommendations, solutions, and action plans for improvement initiatives.
• Ensures contract commitments are met by : gathering, validating, maintaining, summarizing, and / or analyzing provider and contract data of the day-to-day operation and management of services to consult on provider compliance; identifying and documenting provider activities and / or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions; leveraging guidelines to ensure provider compliance with state and federal regulations as well as KP policies and procedures; and consulting with Provider Systems Administration (PSA) or its equivalent as needed to ensure proper contract interpretation and operational readiness and supporting corrective actions as identified through contract performance.
• Supports contract strategy development by : researching, developing, and assisting in the proposal and implementation of strategies that improve access to patient care while managing outside service costs; providing advanced consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies; may include engaging in collaborative cross-functional workgroups to ensure provider strategies meet the unique needs of diverse stakeholders; and may also include developing materials and / or conducting peer training for new hires and contingent workers(e.g., establishing contract language, determining payment rate parameters, defining workflow and business processes, and ensuring cross-training across all service lines).
• Supports the growth of 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; developing and maintaining trusted partnerships with providers to understand their unique service request needs and challenges; serving as a liaison between providers and KP by contributing to communication efforts (e.g., contract compliance such as access, availability, referral operations, and / or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by partnering with others to develop itineraries and agendas, gather credentialing materials, and / or initiate this process.
• Contributes to provider satisfaction by : leveraging in-depth knowledge of provider / contract operations to consult on issues that arise from contract configuration / interpretation and / or related to claims / disputes, billing, payment, reimbursement, other operational issues, and / or directories; ensuring requests for information, questions, and problems are identified, documented, and addressed in a timely manner; and in some instances, collaborating, creating, and / or delivering training materials to aid provider education and orientation on health plan systems, processes, and / or credentialing.

Minimum Qualifications :

Additional Requirements :

Preferred Qualifications :