Under the direction of the Supervisor, Contracts Management, the Senior Contract Manager will collaborate with the Contracts and Provider Relations teams, lead negotiation and implementation of provider contracts with SFHP's network: clinics, medical groups, hospitals, and ancillary providers. You will also collaborate with both external providers of health care services and internal customers to establish and maintain all provider contracts, resolving contract related issues that arise between any internal or external customers. You will anticipate network development opportunities and upcoming regulatory changes to ensure the health plan's network is well-equipped to provide extraordinary care to SFHP's members.
WHAT YOU WILL DO Develop and manage provider contracting efforts and partnerships.Lead the development of contracting strategies based on new or existing initiatives and requirements.Ensure all configuration changes with new or amended contracts are implemented accurately.Acquire and maintain claims processing system knowledge to ensure all configuration changes to new or amended contracts are implemented.Successfully negotiate the terms and conditions of contracts and other transaction documents, finding creative solutions to avoid and resolve potential contractual impasses.Monitor ad-hoc out-of-network service agreements to determine provider contract opportunities.Communicate new and updated contract terms and rates to internal stakeholders.Lead the development of contract templates and amendments.Participate in and support enterprise-wide projects to implement new benefits and products.Analyze health care data for the purposes of contract negotiations.Maintain working relationships with SFHP providers, vendors and medical groups, and internal staff.WHAT YOU WILL BRING 5+ years experience in health care provider contracting in a managed care setting.3+ years experience with Medi-Cal and/or Medicare in a managed care setting.3+ years of direct provider contract negotiation experience.BA/BS in Business, Health Care or related field.Experience with analysis of health care data for the purposes of contract negotiations.Comprehension of legal terms typically found in managed care agreements.Experience with data gathering, and data/report analysis.Detail oriented and organized with the ability to interpret policy and make recommendations.Knowledge of Microsoft Access and Visio.WHAT WE OFFER Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.Vision: Employee vision care coverage is available through Vision Service Plan (VSP).Retirement: Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.Time off: 23 days of Paid Time Off (PTO) and 13 paid holidays.Professional development: Opportunities for tuition reimbursement, professional license/membership.ABOUT SFHP Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.
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