Job Description :
This job manages the business process of contract management with internal departments. The incumbent oversees the staff and facilitates the development/editing and interpretation of provider contract language. Accountable for all contracts including multi-market facility and ancillary agreements as well as value based contracts. Works with the Organization’s internal legal department to develop recommended contracting strategies and interpret contract language and risk. Provides support to markets regarding any terminations including any required regulatory reporting.
- Perform management responsibilities to including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Manage the contract development team and provide process guidance for the development of facility, ancillary, and professional multi-market templates for commercial and Medicare Advantage lines of business covering WPA, CPA, NEPA, statewide PA professional, WV, and DE.
- Serve as the lead in managing contracting life-cycle management (CLM) software; primary liaison to CLM vendor; plan contract integration into the CLM solution; and ensure CLM solution and process meet all regulatory compliance requirements.
- Manage the contract development team and provide process guidance for the development of value-based reimbursement agreements.
- Provide support to the markets in all provider terminations including managing staff in the development of termination notices and serve as the primary contact to applicable regulatory agencies to ensure all reporting obligations and member transition obligations are met.
- Oversee and manage staff in reviewing provider changes including asset sales and mergers.
- Assign and provide guidance to staff in market contract language risk assessments including the interface with legal for joint risk assessments.
- Other duties as assigned.
- Bachelor’s Degree in Business Administration/Management, Procurement or Health Administration
- 6 years management experience or 6 years of contract management experience
- Master’s degree in Business
Any one of the following
- 5 – 7 years in the Healthcare Industry
- 5 – 7 years in Management
- 5 – 7 years in Contract Development
- 1 – 3 years in Legal
LICENSES AND CERTIFICATIONS
- Contract Management
- Business Process
- Operations Management
- Procurement Contracts
- Legal Analysis
Language (other than English)
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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