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HMO Contract Manager in Orange at Prospect Medical Systems

Date Posted: 7/3/2018

Job Snapshot

Job Description



HMO Contract Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The HMO Contract Manager is responsible for coordinating negotiations for new and renewing health plan and hospital contracts and amendments, acts as a liaison with various internal departments and health plans, accepts other duties as assigned for all owned and managed groups. Supports all aspects of Contract Management tasks dealing with RFPs, proposal development and submittal, negotiations, definitization, Proprietary Agreements, Teaming Arrangements and Interdivision Work Orders.



Job Responsibilities/Duties

  • Conducts contract negotiations to ensure purpose, accuracy and profitability of reimbursement structure.

  • Negotiates health plan, hospital contracts, management services agreements, and other contract types as needed.

  • Identify material changes to contracts and work with legal department as needed on these issues.

  • Identify correct reimbursement methodology (per-member-per-month, fee-for-service, capitation, case rate, per diem, DRG, etc.) that is appropriate for contract negotiations.

  • Upon execution of health plan contract provide information to Contract Administrator who will implement roll out meeting and include all impacted departments.

  • Upon execution of hospital agreement or amendment update information in current contract database and submit change form to appropriate personnel/departments.

  • Maintain and update scanned contracts and related documents on appropriate drive Answer and/or resolve urgently needed information sent to the HMO Contracting email box.


Qualifications

Minimum Education:  Bachelor's degree or equivalent education and experience required.

Minimum Experience:  Three (3) year contracting experience related to health care or managed care environment.

Req. Certification/Licensure: None



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit   http://pmh.com/careers/  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: DOFRS, ICD-9, CPT, HCPCS codes, ICD-9, HMO Contract Manager

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