Job description

Located in a scenic and vibrant part of Southern California, this role is with a world-renowned not-for-profit regional health care delivery network performing contract negotions, LOA, and other functions.

The Physician Contract Specialist is responsible for negotiating and executing Physician, hospital and/or other provider contracts and agreements for the organizations capitated HMO population. The Physician Contract Specialist is also responsible for negotiating and executing Letters of Agreements, specialty agreements and ancillary contracting (purchased services) as may be applicable for patients that the hospital or one of their affiliates may have risk for.

Work Schedule: Monday – Friday 8am – 5pm, 100% Onsite required

Essential Job Functions

• Identify and recommend potential provider contracting strategies to reduce costs, limit financial risk and ensure adequate provider network to service members.
• Negotiate provider agreements (physician, hospital, ancillary) within the financial and strategic guidelines established.
• Review and analyze proposed contract terms and conditions of physician/provider contracts and amendments to determine which terms are acceptable and which terms require further negotiation.
• Monitor contract performance against negotiated terms and conditions.
• Maintain a consistent timeline for evaluating contracts and renegotiations.
• Monitor medical group utilization of non-contracted providers and develop action plans as needed to re-educate or obtain contracts
• Monitors and updates contracts required to comply with state and federal law, regulatory or plan requirements.
• Maintain contract database to ensure contracts are archived and available to Hospital Executive Leadership as applicable.
• May assist with identifying and recruiting providers based on network composition and needs.
• Innovates, improves and problem solves to further the goals and achieve the operating and strategic plans of the organization. Identifies opportunities for physician contract improvement.
• Performs other duties as assigned.

Job Requirements

• Minimum 5 years experience in managed care operations within a hospital, IPA or health plan environment with at least 3 years experience in contract negotiations. Bachelor’s Degree in Business Administration or related field or an equivalent combination of education and experience.
• Knowledge of Federal and State laws including Stark and Anti-Kickback as they apply to physician contracts.
• Knowledge of complex reimbursement methodologies
• Excellent communication/interpersonal and organizational skills.
• Ability to problem-solve, analyze situations, and think critically.
• Computer experience and proficiency with MS Word software.
• Ability to work independently, manage multiple time deadlines and work with an atmosphere with frequent changes.
• Comfortable with interaction with all levels of management while maintaining an attitude or professionalism and collaboration.
• Ability to work in a fast-paced environment.

Wollborg Michelson Recruiting does require all applicants to be able to provide proof that they are fully vaccinated from COVID prior to their start date, unless otherwise prohibited by law.
Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

Job Type: Full-time

Pay: $36.00 - $39.00 per hour

Benefits:

• Health insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Newport Beach, CA: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Are you able to provide proof of Covid Vaccination? Deal Breaker

Experience:

• Contract negotiation: 3 years (Required)
• Healthcare: 5 years (Required)

Work Location: One location

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