Payer Contracting Manager - Health Strategy

Location: Brisbane, CA

Job Summary

Applies advanced system concepts, to negotiate and implement large, complex, and/or specialized clinical services contracts with a variety of managed care organizations (MCOs). Reporting to a Director of Payor Strategy in UCSF Healths Department of Health Plan Strategy and Contracting (HPS), the Contracting Manager (CM) is responsible for supporting UCSF Healths managed care contracting and related operational efforts. These include professional and institutional contracts. The role contributes to UCSFs payer contracting strategy development, locally and regionally, and the long-term management of these critical external relationships.

Under supervision of the Director, the position directly negotiates and manages UCSF Healths managed care agreements with designated payers of various types (e.g., commercial managed care plans, government payers, and referring medical groups in northern California, etc.) through the negotiation of contract rates and associated terms for the provision of hospital services, and by serving as a long term owner, relationship manager and operational liaison between these payers and internal UCSF departments who operate under the terms of payer contracts, including Patient Financial Services, Admitting, Care Management, Legal Affairs, School of Medicine administrators and others.

The CM must continuously evaluate the health care market for contracting opportunities, to help the Director and others in HPS develop effective contracting strategies and operational improvements for its facility and physician contracting, including highly specialized hospital payment programs and pricing as well as complex accountable care risk-sharing agreements. The position is responsible for the development and ongoing management of operational tools to assist various UCSF Health teams in their day-to-day operations, and in the resolution of operational issues that arise between contracted payers and UCSF Health.

The CM must be self-directed, have excellent independent judgement, be detail oriented, and a quick-thinking problem solver and negotiator, applying established HPS pricing principles as well as complex UC Regent and HPS language guidelines and other standards, to protect the interests of UCSF Health (hospital and physician) in third party payer negotiations and the associated operations. Exceptional analytical and problem-solving skills are required, as well as in depth knowledge of the health care market, in order to assess contract financial performance and to craft rate and language terms that meet and exceed UCSFs financial targets, and are consistent with UCSFs operations, all in a rapidly evolving healthcare marketplace.

The CM must have excellent interpersonal and relationship management skills, communicating verbally and in writing (on both an ad hoc and ongoing basis) with clients and payers, internal and external to UCSF. The position also serves as an expert on contracting and related operational issues and frequently facilitates the development of innovative solutions to problems that arise in administrating UCSFs contracts.

UCSF Healths Health Plan Strategy & Contracting department is responsible for negotiating all health plan contracts for UCSF Health - commercial and government, including all of UCSF Healths facilities and faculty physicians in the West Bay, East Bay, and for our Clinically Integrated Network (CIN) physicians and related UCSF operated satellite facilities throughout the greater bay area. Commercial and Medi-Cal Managed Care contract revenues are approximately $3.5 billion annually in the West Bay alone, with this contract book accounting for two-thirds of all UCSF Healths clinical revenue.

Contracts include HMO, PPO, ACO, and extensive COE agreements, as well as specialized government contracts. In addition to long-term payer contracts, HPS negotiates more than 1,000 individual patient service agreements annually. HPS negotiates these individual agreements when payers do not have a formal contract with UCSF Health. Most of these agreements cover patients in government programs, primarily Medi-Cal Managed Care organizations and MA plans, and these individual patient agreements with plans help to assure that patients have regional access to required specialty care.

Required Qualifications

• Bachelor's degree in a related area OR four years of relevant experience.
  Four or more years of related experience.
• Advanced knowledge of the full scope of managed care contracting functions and methods, including contract provisions, regulatory, compliance, and privacy issues, procedures and protocols, and customer relations.
• Advanced knowledge of the industry's best practices. Ability to analyze the regional managed care marketplace and the market forces, factors, and organizations that shape it.
• Advanced analysis skills to evaluate the financial performance of contracts. Productive in work volume, speed, quality (great attention to detail), and a good listener/learner.
• Advanced customer service, interpersonal, and teamwork skills to work effectively with clients, prospects, and interdepartmental staff, and to collaborate productively in addressing and solving concerns and problems.
• Advanced critical-thinking, problem-solving, and project-management skills to effectively manage and prioritize multiple levels of information and responsibilities, to successfully manage projects from inception to completion, and to independently assess complex problems and develop an expedient path of resolution.
• Advanced detail orientation, and organizational and project management skills to negotiate, manage, and track complex managed care contracts and effectively carry out all contracting activities simultaneously.
• In-depth knowledge and skills with all relevant software, including specialized contract databases if applicable, as well as data management and analysis tools.
• The ability to work in Brisbane when needed.

Preferred Qualifications

Knowledge of Managed Care, health system, and UC policies and processes. In-depth knowledge of relevant industry federal, state, and local laws and regulations to proactively identify and mitigate compliance risks.

To apply for this position, please use following link:
https://UCSFMC.contacthr.com/144933976