Manager, Network Development & Contracting

Summary/Position Objectives:
Responsible for managing the development of the Provider Network. Manage the negotiations and implementation of cost effective contractual agreements with healthcare providers and institutions that can be administered efficiently and are in compliance with state and federal regulatory requirements. Functions as liaison with other departments to expedite business operations and assists in organizational audits. Maintains contract files to ensure compliance with AHCCCS, HCGA, and NCQA. Responsible for maintaining and managing the assigned day-to-day operations of the Network Development & Contracting department including oversight of Contract Specialists.

Responsibilities:
Essential Functions:
Manages the activities of Contract Specialists including ancillary, physician and ALTCS provider recruiting and contracting activities.
Responsible for participating in organizational audits to ensure organizational compliance with regulatory agencies (AHCCCS, HCGA, and NCQA).
Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savings, while maintaining quality.
Manages and develops the skills of department personnel. Monitors and assesses personnel performance on an ongoing basis. Responsibilities include selection, training, oversight and periodic evaluation of Contract Specialist personnel.
Responsible for ensuring networks adequacy and cost effectiveness in accordance with established minimum standards. Negotiates contracts with new and current providers and issues RFP’s as necessary for key accounts.
Assists in developing, writing, updating and maintaining of departmental policies and procedures.
Develops and maintains the MCP contract templates including securing all required approvals.
Manages initial and ongoing cost/benefit analysis of contracts to determine cost effectiveness, renegotiating as appropriate. Manages annual analysis & reconciliations of major contracts.
Manages implementation of new contracts with departments involved.
Serves as an internal resource to MCP departments regarding managed care and contractual issues as they arise, and participates in various Committee meetings.
Manages the process of appropriate legal / regulatory review of contracts prior to execution.
Drafts, recommends and writes both standard and specialized contracts, ensuring that all required components are included.
Negotiates and amends contracts as required per updated new AHCCCS mandates.
Manages the process of the system configuration requests for all provider network changes and modifications; and ensures compliance with AHCCCS technical requirements for reporting and encounter submission.
Manages the monthly and quarterly meetings with Ancillary providers
Performs other duties, assignments and responsibilities as assigned or required.







Secondary Functions:
Management of multiple projects simultaneously.
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)
REQUIREMENTS
Knowledge and Skills:
Percentages, ratios, addition, subtraction, multiplication and division.
Complex decision making responsibility. Requires application of analytical methods to develop new approaches or alternatives, and considerable judgment is required to select appropriate solution.
Strong analytical capability.
Must be able to understand and correct moderately complex logical problems.
Communicates, writes, advises and counsels on extremely complex matters.
Personal computer skills including various types of software applications.

Education and Work Experience:
Bachelor degree in closely related field is preferred, although an equivalent combination of formal education and experience may substitute for a degree. A minimum of five years experience in managed care, three of which were in a management capacity. A minimum of three years of Health Plan or Provider Contract Negotiation Experience. Network Management and contracting experience preferred.

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k)
* Tuition reimbursement
Visit www.schalleranderson.com for more information or submit a resume to [Click here for email]. EOE