CenCal Health is the healthcare administrator for Medi-Cal in Santa Barbara and San Luis Counties.  

Responsible for maintaining, monitoring and coordinating provider contracts. Responsibilities include, but are not limited to:

· Negotiating high priority physician group and facility contracts using Preferred, Acceptable, Discouraged and Unacceptable (PADU) guidelines

· Engaging targeted contracted providers in renegotiation of rates and/or language

• Recruitment of additional providers and/or specialty treatment services for identified populations
• Builds and maintains a robust provider network dedicated to serving the low income population to provide access to high quality healthcare services.

· Assisting with cost contract strategies that positively affect the Medical Loss Ratio (MLR).

· Assessing contract language for compliance with CenCal’s standards and regulatory requirements and incorporates required languages into provider agreements. Reviews revised language with Legal Affairs

· Participating in fee schedule determinations including development of new reimbursement models. Seeks input on value based payment models and new reimbursement models

· Developing and maintaining a work plan and timeline for completing contract negotiations and re-negotiations, and ensuring that contracts and amendments are implemented in a timely fashion

· Composing, updating, and overseeing compliance with Provider Services Contracting policies & procedures. Maintain contracting protocols, payment matrix and tracking system

· Developing and maintaining various contract types and amendments in utilizing contract management software, ensuring consistency and accuracy

• Participating on workgroups and committees designed to monitor member access to care, oversee expenses and utilization and provider service indicators
• Working closely with Provider Network and Configuration Analysts to implement provider contracts and amendments
• Running status reports according to Departmental procedures and oversees contract related requests resulting from State or regulatory audits
• Conducting training of Provider Services staff regarding contracts and follows up with providers to ensure the return of all new contracts or amendments

· Assisting the Associate Director of Provider Services with special projects including process improvements and making recommendations for improvement of any and all procedures and systems at CenCal Health

Skills/Knowledge/Abilities (Indicate Required or Desired)
• Excellent negotiation, oral and written communication skills
• Excellent analytical and research skills
• Ability to multi-task and respond under pressure
• Superior interpersonal and problem solving skills, organizational and planning skills
• Strong ability to be flexible and manage change
• Excellent computer skills (i.e., Microsoft Word, Excel, Power Point)
• Knowledge of Medi-Cal managed care, physician, and hospital contracting required
• Knowledge of contract management software programs strongly desired
• Must be able to work full time

Education and Experience 
• BS and/or equivalent; Master’s degree desired
• Five (5) years’ experience in Managed Care Plan or Health Systems (Medicaid preferred) 
• Five (5) years supervisory and management experience
• Familiarity with various provider payment methodologies including APR-DRG, capitation, fee for service, bundled payments, population health, and value based payment models and alternative payment methods
• Understand regulatory compliance audits of health plans and be prepared to respond 
• Prior training and/or knowledge in in HIPPA, Knox Keene Health Care Service Plan Act of 1975, Medi-Cal, Medicare and CMS regulations
• Familiarity with contract terms and legal language
• Strong understanding of network adequacy requirements and Quest analytics

If you are interested in joining the team at CenCal Health, please submit your resume at Apply at https://workforcenow.adp.com/jobs/apply/posting.html?client=cencalhlth&jobId=29047&lang=en_US&source=CC3

We offer competitive salaries and a great benefits package. EOE

For a complete listing of our open positions, please visit our website, www.cencalhealth.org.