- Bachelor’s degree or equivalent experience in business, finance, healthcare administration or related field.
- Minimum of 5 years progressive responsibility and quantifiable results in network development and delivery system negotiations.
- Extensive knowledge of hospital, physician, and ancillary provider reimbursement methods for commercial and government payers, including pay for performance models.
- Minimum five years of experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
- Knowledge of network development, provider network clinical and business operations, provider relationship management, reimbursement analysis, contract performance analysis.
- General knowledge of legislative and government activities and marketplace issues affecting the region preferred.
- Comprehensive knowledge of Medicare and Medicaid payment methodologies, level of care pricing, and federal and state health care regulations.
- Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiations, interpersonal relations, oral and written communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation and project management.
- Must be a “self-starter” with a strong sense of initiative and follow-through. Ability to work independently under high-pressure circumstances with little or no supervision.
- Software skills including Microsoft Word, Excel, PowerPoint, Access, Project, and Visio preferred.
- Valid Oregon or Washington driver’s license and active auto insurance.
- Budget Responsibility: The Senior Contract Manager has no direct KPNW operating budget responsibility, per se, since the Senior Contract Manager negotiates contracts which are part of the overall budget responsibility of a NWP Service Chief/Department Administrator or a KFHP Operations Leader (e.g. the Director of Continuing Care Services). It should be noted, however, that the Senior Contract Manager has significant influence on KPNW’s operating budget in their ability to negotiate cost-effective financial terms and payment strategies.
- Ability to negotiate cost effective contracts to meet operating budget targets in an environment where KPNW holds little to no leverage, and provider relationships are challenged due to KPNW’s internalization and care delivery strategies.
- Ability to meet operating budget targets.
- Able to consistently satisfy demanding internal clients and to handle the constant pressure of multiple simultaneous projects with competing priorities and deadlines.
- Due to the demands placed upon the Provider Contracting Department, the pace is rapid and dynamic, sometimes causing project priorities to rapidly and significantly shift. Ability to work in a high pressure environment with sometimes limited resources while expected to meet aggressive project timelines.
Internal Project Team Skills
- Ability to develop & maintain trusting relationships with internal KPNW staff and leadership.
- Ability to listen to KPNW Clinical Leadership’s care delivery needs in contracted provider relationships and associated operating budget constraints, and to translate these needs into an effective contracted relationship.
External Practitioner/Provider Skills
- Ability to develop & maintain trusting relationships with contracted providers (Physicians, Physician Administrators, Hospital CEO’s, COO’s and CFO’s.
- Ability to consistently and effectively negotiate sound contracts with targeted providers utilizing astute management of each stage of the negotiation; appropriately escalating outstanding business and clinical issues to leadership.
- Ability to work effectively and diplomatically with the leadership of contracted providers to address contract interpretation, performance, and enforcement issues.
- Ability to work effectively and collaboratively with representatives from other NWP and Health Plan departments, and/or other KP regions.
- The stress level can be above average at times due to the difficulty of negotiating provider contracts within prescribed deadlines and operating budgets.
- In order to meet with physicians, providers and/or other administrative staff when they are available, there are frequent early morning and early evening meetings.
- Position will require some overnight travel around the Pacific Northwest.
- Position will require accessing some non-Kaiser provider offices which may not be ADA accessible.
Preferred Education & Qualifications
- Master’s degree in business, finance, healthcare administration or a related field.
- Minimum of 7 years progressive responsibility and quantifiable results in network development and delivery system negotiations.
- Minimum of 7 years of experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
- Minimum of 5 years progressively responsible management experience at Kaiser Permanente (preferred) or an HMO/healthcare setting similar in size and complexity to Kaiser Permanente.
- Extensive knowledge of network development, provider network operations, provider relationship management, reimbursement analysis, contract performance analysis required.
- Comprehensive knowledge of legislative and government activities and marketplace issues affecting the region
At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.