Senior Director Provider Contracting
Company: Kaiser Permanente
Posted on: February 15, 2019
Description: Collaborates with regional health plan and medical group executives to lead and negotiate cost-effective, quality-oriented contracts for hospital, ancillary, and non-MD/DO services. Responsible for leading all network provider relationships as it relates to Health Plan operations. Plays a pivotal role in managing and analyzing external medical costs and achieving the regional network contracting and provider relations strategies. Negotiates purchase of hospital and ancillary based services; accountable for hospital/ ancillary network development and management & financial performance in an effort to achieve regional business goals. This position consistently supports compliance & the Principles of Responsibility (KP's Code of Conduct) by maintaining the privacy & confidentiality of information, protecting the assets of the organization, complying with all applicable regulations, & acting w/ ethics & integrity. Additionally, position will focus on managing new innovative provider contracting methodologies from design through contract execution and operational readiness. These new generation agreements will deliver performance based reimbursement methods that align external providers to Kaiser Permanente's goals for affordability and quality health care delivery. In collaboration across multiple health plan departments, provides strategic design and management oversight to execution of performance based provider contracting agreements. Uses data and evidence-based practices to objectively identify opportunities around healthcare costs and trends to strategically create competitive advantages for the organization and network development team. Ensures alignment with strategic initiatives, as well as effectively leveraging business intelligence, financial and reporting tools. Essential Responsibilities: Strategic - Ability to analyze, evaluate, articulate strategic issues & solutions. Analytical skills, to evaluate & fully understand financial models for negotiations & be a sharp thinker during financial negotiations. Build & manage internal & external relationship that is based on consistent follow ups, factual information, & ability to demonstrate skills & knowledge to gain credibility. Have a solid understanding & experience to recognize the End-to-End aspects of the Provider Contracting involving Claims, configuration, UM, contract modeling and analytics, etc. Provides strategic input based on market analysis, KPWA strategic externalization needs, facts & EMC data & assists the executive director in decisions on Kaiser's hospital & ancillary network design, network adequacy & geographic expansion activities. Lead negotiator in complex hospital and ancillary negotiations for the provision of cost effective medical services. Has authority to design and implement negotiated agreements and manages internal approval of agreements reviewed at the Hospital Contracting and Strategy Committee. Lead the NDPC analytics team to provide timely, accurate, critical analysis of external medical costs, trends, and network affordability opportunities. The new alignment of medical cost analytics to NDPC is designed to enhance the robust nature of this function. In turn, this alignment will drive improvement opportunities in hospital/ancillary operations and contracting strategies that bring an integrated focus to both unit cost and units of service. Recommends adjustments to strategies to meet changing business & market conditions as well as successful financial & quality based performance. Works collaboratively with the Medical Group in developing & communicating negotiation strategies & tactical approaches, including value based contracting outcomes. Assists in the development of hospital and ancillary contracting, network management & provider relations capabilities within KPWA; developing policies & procedures & best practices to ensure that contracting processes support the WA region's business goals. Builds & maintains collaborative relationships w/ hospital & system executives as well as medical group & health plan leadership including but not limited to claims, UM, sales & marketing, actuarial, quality, operations & finance to ensure successful implementation of initiatives. Assists in the development of contract models & performance standards & assesses contract performance against those standards. Identifies & implements strategies for improvement of the medical loss ratio through the enhancement of external medical cost analytics. Leads the provider contracting and analytic management team who oversee the day to day operational activities of the provider contracting and analytic staff. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors. Basic Qualifications: Experience Minimum ten (10) years of increasingly responsible health care management experience that demonstrates ability in successfully working with executive leadership teams, developing & implementing hospital/facility contracts, provider relations and/or network management, as well as supervising staff. Education Master's degree in Health Care Administration, Business Administration or related field OR six (6) years of experience in a directly related field. High School Diploma OR General Education Development (GED) required. License, Certification, Registration N/A Additional Requirements: Extensive knowledge of health care, compliance/regulatory, clinical & operational matters. Preferred Qualifications: Specific experience in hospital financial management is preferred. Experience working with care delivery operations and business transaction operations (e.g. claims) is preferred. Primary Location: Washington,Renton,Renton Administration - Baker 1300 SW 27th St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Director/Senior Director Job Category: External Medical Services Department: HP Mgr-Pricing/Ops-Contrcts Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. Click here for additional requirements > SDL2017
Keywords: Kaiser Permanente, Seattle , Senior Director Provider Contracting, Executive , Renton, Washington
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