Director Provider Contracting

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California

Responsibilities

• This position is work from home within California, with the possibility of onsite meetings.
  
  
  

Position Summary:

Assess and develop networks to support Network and contract performance. Provider contracting including data gathering and analysis, contract preparation, outreach and follow-up with providers, negotiating and secure contracts with physicians, facilities and ancillary providers. Oversee the implementation of all contracts including collaboration with the Provider Relations team for health plan agreements. Provides support to Dignity Health MSO Administration and staff in evaluating and implanting contract terms. Review and update contract language to be in compliance with State and Federal regulatory requirements. Analyze and assess participating provider networks and projected network needs to ensure network adequacy. Organizes contract information and ensures that timely information is provided to key stakeholders involved in implementing contract changes.

Responsibilities may include:

• Supervise all contracting staff including performance, development, recruiting talent and all staff management.
• Oversee and develop department budget.
• Draft, negotiate and maintain physician, facility and ancillary provider agreements for Dignity Health MSO and its clients.
• Assist with health plan negotiations; conduct initial review of provider proposals and make recommendations to Administration for response.
• Lead the implementation of contracts including review of fee sets, division of financial responsibilities, and provider information.
• Develop agenda and presentation for Contracting Meetings.
• Serve as content specialist resource for all Dignity Health MSO departments (i.e., Claims, Utilization Management and Authorizations, Benefits, and Finance) providing contract interpretation, clarification, or modification.
• Serve as a content resource for all Dignity Health MSO clients (i.e., Physician Office Staff, Ancillary Provider Contracting Representatives, and Health Plans) providing contract interpretation, clarification, or modification.
• Lead communication to Administration in preparing internal and external correspondence documenting new contracts, contract amendments, and contract terminations.
• Ensure contract databases and files are organized and information is readily available for review and research.
• Negotiate letters of agreement required for care coordination with non-network providers.
  
  
  

Qualifications

Minimum Qualifications:

• 5 years’ experience in contracting, managing service agreements, or providing paralegal services
• Experience in the managed care field, with an IPA, health plan, or other healthcare related environment.
• Bachelor’s degree in Healthcare or Business Administration
  
  
  

Preferred Qualifications:

• Supervisory experience
  
  
  

Pay Range

$49.20 - $71.34 /hour