Current Emanate Health Employees - Please log into your Workday account to apply

Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.

Job Summary

Negotiates, operationalizes and manages contracts with all payers, e.g., insurance companies, MSOs and TPAs. Assures contractual arrangements meet financial targets and legal/regulatory compliance requirements. Facilitates the approval process of all contract documents from pre-contract through post-signature phases. Responsible for the accuracy of supporting documentation for contracts and completing documents accurately. Maintains processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements). Maintains existing relationships with contracted payers and providers. Ensures contractual language is current. Coordinates and communicates contractual terms to the required internal departments. Develops and maintains periodic (e.g., bi-weekly) reports on the status of all contracts. Maintains excellent written and verbal communication with all internal and external customers. Ensures provider reimbursement and language negotiations align with company guidelines. Collaborates with internal and external stakeholders to understand their needs and requirements. Collaborates with legal counsel to ensure contracts are compliant, mitigate risks, and resolve disputes. Coordinates with providers and credentialing department to ensure compliance and completeness. Leads collaboration efforts with other business units to complete contracting, process improvements, and system enhancements on behalf of Contracting. Oversees special projects. Assists with all contracting administration and projects, as assigned. Manages Capitation Claims Operations, staff and vendors including, but not limited to, Health Plans claims audit. Evaluates, negotiates and executes a wide variety of different contracts and transactions. Negotiates HMO, PPO, Medicare and Medi-Cal agreements including full risk arrangements. Creates and maintains relationships with payers and serves as point of contact for matters concerning contracts. Maintains records for correspondence and documentation in relation to established contracts and those in progress. Monitors contracts and moves forward with close-out, extension or renewal according to what’s best for Emanate Health. Solves any contract-related problems that may arise with other parties and internally with Emanate Health itself. Assists in developing presentation materials for internal and external meetings. Provides information to support strategic planning and other management decisions.

Job Requirements

Minimum Education Requirement :

Bachelor's degree in a related field preferred.

Minimum Experience Requirement :

Five years' managed care negotiation experience. HMO hospital agreement negotiation experience required. Excellent customer service skills required.

Delivering world-class health care one patient at a time.

Pay Range:

$53.37 - $78.45