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VN1152
Director of Contracting, Hospital and Physician Services
Charlestown
 
The Director of Contracting, Hospital and Physician Services will be responsible for obtaining and maintaining a network of hospital and physicians to meet the needs of CCA members, maintain CCA’s high quality ratings, support financial sustainability. In addition, this individual will help design and execute reimbursement strategies to achieve these goals.

​Minimum Education Required
Bachelor's Degree required; Master’s Degree preferred

Minimum Experience Required
7- 10 years in managed health care
•    Minimum seven years of experience in health care, with minimum five years in provider contracting
•    Experience with leadership in provider contracting and health care reimbursement
•    Must have supervisory experience and demonstrated ability to work with staff to achieve goals
•    Experience with hospital, physician, and performance-based primary care and health system contracting required

Knowledge, Skills and Abilities
•    Experience with leadership in provider contracting and health care reimbursement
•    Must have supervisory experience and demonstrated ability to work with staff to achieve goals
•    Experience with hospital, physician, and performance-based primary care and health system contracting required

Key Responsibilities
  • Lead the development and maintenance of the CCA Hospital and Physician  network through the management of the Hospital and Physician contracting team, oversight of contract negotiations, and provider relationship development
  • Provide strong leadership and management to staff of contract managers and contract specialists, including the development and maintenance of work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence
  • Develop and execute contracting strategies contracts that support the clinical, programmatic, and financial goals of the organization
  • Work with leadership and contracting team to strategize and prioritize provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements
  • Oversee and directly lead the pursuit, negotiation, analysis, and implementation of fee-for-service and performance and risk-based health system and primary care agreements
  • Effectively and professionally represent CCA with providers and provider organizations.
  • Maintains positive working relationships with contracted providers, systems, and institutions.
  • Has ability to identify synergy between CCA and potential new providers, and effectively implement and maintain these new provider relationships
  • Is able to effectively promote and convey the concept of CCA’s Care System Design of full integration of medical, behavioral health and long-term care services to new providers
  • Develop and maintain work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence
  • Provide coaching, mentorship, support, and oversight in the contracting and contract negotiation process, drawing upon experience and subject matter expertise
 
 Secondary Responsibilities
  • Collaborates with and builds strong partnerships across the organization to align network recruitment and management activities with membership and clinical care goals, regulatory compliance, and other organizational priorities
  • Possess a solid understanding of Medicare and Medicaid reimbursement methodologies
  • Actively participates in the evaluation of own performance
 
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws
 
 
    
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