MANAGER OF PROVIDER NETWORK AND CONTRACTING, COUNTYCARE
Job Number: 00120388
Job Posting: Apr 19, 2017, 10:35:32 AM
Closing Date: May 4, 2017, 12:59:00 AM Full-time A.M. P.M.
Collective Bargaining Unit: None Posting Salary: COMPETITIVE SALARY
Organization: Health and Hospital Systems
The Manager of Provider Network and Contracting, CountyCare is responsible for leading the development, negotiation, and coordination of activities of the provider contracting and network development functions. Manages the implementation of contracting strategies with physicians, facilities, and ancillary providers. Negotiates large hospital, physician groups and ancillary service agreements in accordance with health plan and government regulations and guidelines. Manages and monitors contractual relationships with existing contracted providers.
General Administrative Responsibilities
- Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
- Participate in collective bargaining negotiations, caucus discussions and working meeting
- Document, recommend and effectuate discipline at all levels
- Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
- Initiate, authorize and complete disciplinary action pursuant to CCHHS system rules, policies, procedures and provision of applicable collective bargaining agreements
- Direct and effectuate CCHHS management policies practices
- Access and proficiently navigate CCHHS records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
- Contribute to the management of CCHHS staff and CCHHS' systemic development and success
- Discuss and develop CCHHS system policy and procedure
- Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire. transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
- Work with Labor Relations to discern past practice when necessary
- Develops and implements a network development plan and initiates contact with providers in support of the health plans strategic goals and objectives.
- Meets with providers to discuss the benefits of the CountyCare health plan and contract requirements.
- Develops and negotiates various reimbursement methodologies with providers including capitation, and fee for service payments.
- Provides oversight to the provider set up and contract configuration in the claims system to ensure accurate claims adjudication.
- Evaluates and monitor provider performance standards and financial performance of contracts.
- Consults with finance team to perform analyses to identify medical cost improvement opportunities and develop strategies to achieve outcomes.
- Coordinates with the Executive team, Legal and Regulatory Affairs to prepare and update contracts and related materials, as necessary for new contracting initiatives and regulatory and business changes.
- Develops strategic recommendations regarding the provider network contracting needs of the organization.
- Oversees day to day responsibilities of the department including the completion of Letters of Agreement, receipt and distribution of contracts and amendments.
- Collaborates with the financial team to perform analysis of contract financial terms.
- Manages contracting department staff.
- Participates in the interviewing, hiring, training and development of staff.
- Works effectively with senior executives and other leadership on contracting initiatives.
- Works effectively in a collaborative and coordinated manner with other key departments regarding provider network contracting needs.
- Manages and review provider contracting details; communicates to internal departments as appropriate.
- Identifies and corrects contract term issues.
- Maintains confidentiality with patient information per HIPAA guidelines.
- Performs other duties as required.
- Bachelor's degree from an accredited college or university (must provide official transcripts at time of interview)
- Five (5) years of managed health care experience, including provider network or health service contracting for an integrated delivery system or managed care organization. (is required)
- Experience negotiating hospital, large physician groups or ancillary service agreements. (is required)
- Experience in provider network management and Medicaid/Medicare contracting for a large health system or managed care organization. (is required)
- Must be able to travel throughout Cook County. (is required)
- Valid Illinois Driver's license and mandatory vehicle insurance as required in the State of Illinois (In accordance with the Code of Ordinances of Cook County, Illinois codified through Ordinance No. 16-0692, enacted February 10, 2016 (Supp. No. 32) Sec. 2-673). is required (must provide proof at time of interview)
Knowledge, Skills, Abilities and Other Characteristics
- Bachelor's degree or higher in Business Administration, Public Policy, Health Care Administration, or a related field of study from an accredited college or university
- Knowledge of provider networking contracting
- Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
- Excellent program development, management and leadership skills
- Effective negotiation skills
- Demonstrate attention to detail, accuracy and precision
- Ability to prioritize, plan and organize projects and tasks
- Ability to train by presenting concepts and demonstrating tasks
- Ability to perform accurate and reliable mathematical estimates
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, Are you a Military Veteran?
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER