ChulaVistaRecruiter Since 2001
the smart solution for Chula Vista jobs

Director Contract Administration

Company: Community Health Group
Location: Chula Vista
Posted on: January 12, 2021

Job Description:

POSITION SUMMARY Provides exemplary contracting services to CHG's providers by managing the Contracting Department's System Set-Up (configuration) Team and Network Committee team functions and resources; leading and managing the work efforts of the department's staff; coordinating contractual activities with other departments; maintaining service levels in compliance to federal, state law.COMPLIANCE WITH REGULATIONS:Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including, CMS and/or Medicare Part C and Coordinated Care Initiative.RESPONSIBILITIES * Develops and maintains contract templates for CHG contracting providers - updated annually. * Communicates with provider staff and resolves issues by relaying CHG's philosophy of member management, commitment to quality care and cooperative network development; meeting with various CHG departments/staff to review direct contract issues; developing solutions to problems; reviewing reimbursement provisions, utilization data, cost reports and enrollment reports; assisting with the dissemination of practice profiling information.* Plans department operations by promoting teamwork and motivating staff to accomplish tasks; assuring availability of developmental and training opportunities for team members; providing guidance to team members in all related activities, including production and operations; managing administrative and personnel issues; selecting, training and orienting staff; providing education for staff; monitoring and supervising work, evaluating performance; recommending personnel actions; developing and maintaining job descriptions for staff members.* Communicates with the Director of Claims Administration, Director of Utilization Management, Senior Director of Health Care Services and Senior Director of Operations to review contracts prior to contract issuance to ensure optimum claims adjudication compatibility and referrals/authorizations compatibility.* Delivers high quality contracting services by planning, implementing, and managing Contracting Department programs designed to enhance the timely production of contracts; negotiating financial contracts with CHG's providers.* Ensures network adequacy in compliance with regulatory requirements.Draft and review contracts and, as needed, Letters of Agreement, to protect the interests of CHG and its members. Make recommendations to the Chief Operating Officer to meet the needs of CHG clinical team.* Ensure the delivery of timely and accurate government reports as necessary.* Supervise the Contracting Department Contract Development Manager and Administrative Assistant.* Keeps management informed by communicating and interpreting changes in guidelines, policies, procedures and regulatory requirements; keeping administration informed of department activities, needs and problems; maintaining close liaison with other departments to assure coordination, standardization and continuity; keeping abreast of appropriate regulatory agency requirements; preparing an annual report of the activities of the Contracting Department.* Maintains professional and Technical knowledge by attending educational workshops; reviewing professional publications; establishing and maintaining personal networks; participating in professional healthcare related activities.* Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.Education:* Bachelor's Degree in Business Administration or Health Care Administration.* Master's Degree in Healthcare Administration, Business Administration or related field required.Experience/Skills:* 5 years of contracting experience in a managed care environment, including contract development, negotiation, and administration. 3 years supervisory experience.* Strong knowledge and understanding of federal, state and local healthcare regulations. Familiarity with Medicaid, CCS. CMS/Medicare, DMHC and DHCS.* Excellent analytical skills; ability to communicate effectively, both verbally and in writing; ability to establish and/or build relationships with providers and regulatory agencies; strong management and leadership skills.Physical Requirements:* May require prolonged sitting.* Frequent traveling, including driving within County of San Diego.* May be required to work evenings and weekends.QualificationsEducation: * Bachelor's Degree in Business Administration or Health Care Administration.* Master's Degree in Healthcare Administration, Business Administration or related field required.Experience/Skills:* 5 years of contracting experience in a managed care environment, including contract development, negotiation, and administration. 3 years supervisory experience.* Strong knowledge and understanding of federal, state and local healthcare regulations. Familiarity with Medicaid, CCS. CMS/Medicare, DMHC and DHCS.* Excellent analytical skills; ability to communicate effectively, both verbally and in writing; ability to establish and/or build relationships with providers and regulatory agencies; strong management and leadership skills.Physical Requirements:* May require prolonged sitting.* Frequent traveling, including driving within County of San Diego.* May be required to work evenings and weekends.

Keywords: Community Health Group, Chula Vista , Director Contract Administration, Executive , Chula Vista, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Sr. Software Development Manager (TurboTax)
Description: OverviewCome join the Intuit as a Senior Development Manager for TurboTax Platform Team. The TurboTax Platform team is responsible for managing the platform and tax engine that powers a 3.5 Billion dollar (more...)
Company: Intuit
Location: San Diego
Posted on: 01/23/2021

Branch Manager
Description: Summary The Branch Manager is responsible for managing the day-to-day sales activities of their branch and overall origination processes within defined targeted goals. This position will work the loan (more...)
Company: Freedom Mortgage
Location: Carlsbad
Posted on: 01/23/2021

Senior Product Manager
Description: Senior Product ManagerCarlsbad, CA /Product - Product /Full TimeAs a leading mobile games developer, Jam City is looking to level up our talent. We're on the hunt for innovators who consider themselves (more...)
Company: Jam City
Location: Carlsbad
Posted on: 01/23/2021


Director of Transmission
Description: Director of Transmission Oscar Energy is currently working exclusively with one of North America's leading renewable energy project Developer/ Owner/ Operators who is seeking an experienced Director of (more...)
Company: Oscar Associates Limited (US)
Location: San Diego
Posted on: 01/23/2021

Salon Manager
Description: Job DescriptionGot shears and a winning attitude Have a yearning to earn and a desire to hire and support other stylists Then let's talk Maybe you're a stylist who wants more
Company: Great Clips
Location: Imperial Beach
Posted on: 01/23/2021

Sr. Manager/Director, Software Engineering of Conversational
Description: Sr. Manager/Director, Software Engineering of Conversational Interface Platform - 32209 Engineering, Infrastructure and Operations Santa Clara, California DescriptionSenior Manager/Director, Software (more...)
Company: ServiceNow
Location: San Diego
Posted on: 01/23/2021

Staff / Director, Product Management - Automotive Telematics
Description: Staff / Director, Product Management - Automotive Telematics Software br Company:Qualcomm Technologies, Inc.Job Area:Operations Group, Operations Group Product ManagementJob Overview: Qualcomm is (more...)
Company: Qualcomm CDMA Technologies GmbH
Location: San Diego
Posted on: 01/23/2021

Senior Scientist/ Associate Director
Description: US-CA-San DiegoID: 2020-1388Category: Research DevelopmentOverview br br AlivaMab Discovery Services ADS seeks an outstanding individual with strong experience leading therapeutic antibody discovery (more...)
Company: AlivaMab Discovery Services
Location: San Diego
Posted on: 01/23/2021

Brookdale Senior Living: Rn Case Manager
Description: Job DescriptionOverview Make Lives Better Including Your Own. The happiness of those we serve is dependent on the happiness of our associates, so you'll receive competitive compensation and a benefits (more...)
Company: Brookdale Senior Living
Location: San Diego
Posted on: 01/23/2021

Program Manager 2 - COIC Ceramics
Description: Job DescriptionEmbark on a career putting innovative, reliable, and agile products and ideas into orbit, and beyond. Northrop Grumman has opportunities waiting for you that play a vital role in human (more...)
Company: Northrop Grumman
Location: San Diego
Posted on: 01/23/2021

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Chula Vista RSS job feeds