Kaiser Permanente Contracts Administrator (Outside Medical) in Fontana, California
Consultants with SA leadership to develop and implement a cost effective and marketable service delivery network with outside health care providers for hospital and ancillary services for the Service Area. Functions as the point person for the SA, integrating Area and Division efforts in managing contracts and relationships with outside providers for the delivery of health care to Kaiser members.
Essential Responsibilities: - Consults with SA leadership and internal clients to develop and implement short and long range business strategies that utilize external provider alliances as part of an integrated care delivery strategy for each clinical department, primary care unit, and secondary service line. - Coordinates development activities with Divisional contracting staff. - Conducts cost benefit options and opportunity analyses for outside contracting alliances. - Models and analyzes costs and financial considerations for full service and specialty services with outside health care providers (e.g., hospital alliances partners, hospitals, ancillary providers and primary suppliers) for 'make vs buy' care delivery decisions. - Identifies potential partners/alliances for the Service Area that provide quality service at an affordable price. - Communicates operational, utilization cost, quality and service expectations to potential providers/network alliance. - Assumes responsibility at the Service Area level for managing alliances and relationships with external providers. - Coordinates efforts with local UR/QM to develop operational performance, clinical and customer-oriented measures, and reporting guidelines for external contracts. - Oversees the resolution of day-to-day operational issues such as membership eligibility, referral authorization, and payment issues with affiliated providers. - Assures problems/issues are identified, discussed, documented and resolved. - Provides project management for SA sponsored initiatives relating to outside providers and network alliances. - Monitors external health care delivery marketplace and internal utilization trends to assess new opportunities for cost savings, alternative delivery models and financial risk sharing.
Qualifications: Basic Qualifications: Experience - Minimum five (5) years of progressive experience in health care management, with a minimum two (2) years in contracts management. Education - Bachelor's degree in health care, business administration or related field required; OR four (4) years of experience in a directly related field. - High School Diploma or GED License, Certification, Registration - N/A.
Additional Requirements: - Excellent understanding of health care service industry, competitive market strategies and hospital operations. - Previous experience working with various payment methodologies and spreadsheet analysis, hospital and ancillary providers and physicians. - Demonstrated ability to work independently with a variety of internal and external personnel at all organization levels. - Strong project management, leadership and communication skills required. - Strong financial and analytical skills with experience analyzing medical expenses and utilization. - Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications: - Master's degree or equivalent experience in health care administration, business administration strongly preferred.
COMPANY Kaiser PermanenteTITLE Contracts Administrator (Outside Medical)LOCATION Fontana, CAREQNUMBER 594978
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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.