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Director, Regional Contracts - Long Beach California
Company: SCAN Health Plan
Location: Long Beach, California
Posted On: 11/21/2024
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visitwww.thescangroup.org ,www.scanhealthplan.com , or follow us on LinkedIn ;Facebook ; andTwitter .The JobThe Director, Regional Contracts shall, in concert with the Senior Regional Director and as an integral member of the Network Management team, develop and manage business partnerships with SCAN value-based and fee-for-service provider contracting and network management activities to support achievement of SCAN's goals including margin, quality measures, and achievement of our mission to enhance senior's ability to manage their health and live independently.You WillThis role is a key contributor who will evaluate, negotiate and prepare contracts in a fiscally responsible manner to ensure a sustainable, high quality, compliant network for assigned regions and complex provider contracts in all regions. Advise Regional Contracts Managers and other Network Management staff. Contracts include capitated delegated and fee-for-service medical groups, IPAs and hospitals. Provide direction to internal business units to identify and model expected yield of alternate terms for high spend or complex provider contracts, monitor actual contract performance, test the feasibility of non-template terms and conditions to identify the most favorable solution and follows appropriate approval process.Proactively build relationships that nurture partnerships with SCAN's contracted network providers, including medical groups, IPAs and hospitals and ensures the network composition includes an appropriate distribution of required professional and facility services.Ensure provider contracts accurate implementation and administration. Accountable for assigned regional and complex provider network performance related to financial, operational, regulatory, quality and member satisfaction targets. Develop and execute provider specific performance improvement plans, based on needs identified via Provider Dashboard metrics that highlight operational, quality, financial and compliance-based measures.Utilize contracting knowledge for effective problem resolution, compliance and Network Management staff guidance. Responsible for timely and professional interaction in response to contract related inquiries. Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.Participate in regularly scheduled Joint Operations Committee meetings (JOCs). These meetings will discuss operational issues relative to all parties, including, but not limited to: utilization, financial, enrollment, grievances, provider termination/panel closures, continuity of care, marketing campaigns, etc.Responsible for assuring that the day to day operations of the provider network are consistent with SCAN standards/ expectations. Assist in resolving elevated and complex provider service complaints.Act as technical resource on contract related issues and offer strong leadership internally as well as externally. Initiate and maintain effective channels of communication with key internal partners including but not limited to Legal, Compliance, Delegation Oversight, HealthCare Services, Finance, Claims and Sales.Participate in interdepartmental meetings and selected committees and substituting for the Senior Director, Regional Network Management on an as needed basis. Provide mentoring to Regional Contracts Managers and other Network Management colleagues.Develop goals and objectives, in concert with Senior Director, Regional Network Management that align with the organization's vision for future growth and network development.Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Contribute to team effort by accomplishing related results as needed.Actively support the achievement of SCAN's Vision and Goals.Other duties as assigned.Your QualificationsBachelor's Degree or equivalent experience6+ years managed care contracting experience involving complex delivery systems and organizations required. Prior Medicare Advantage health plan experience required. Superior communication skills, problem solving and decision-making.5+ years of leadership experienceKnowledge of CMS, DHCS and other regulatory requirements required.Strong analytic, quantitative, and problem-solving skills required.Strong negotiation, interpersonal and presentation skills with an ability to appropriately and effectively address diverse audiences required.What's in it for you? |
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