Director, Medi-Cal Regulatory Strategy and Contracts
Company: Kaiser Permanente
Posted on: September 13, 2020
We're looking for a candidate to fill this position in an
- Negotiates highly complex financially competitive and
predictable contracts. This includes leading collaboration with
Actuarial Services, Legal, and internal advisors when appropriate.
Evaluates multiple contract scenarios and modeling to provide the
best quality, price, and service while ensuring contract
responsibilities are aligned with internal operational
- Coordinates multi-Regional Plan Partner contract negotiations
and employs project management skills and resources to develop
project plans, identify milestones, identify resource requirements
and manage the project. As part of contract negotiations,
determines quality standards to be included in contracts, develops
appropriate metrics, and plans for ensuring quality standards are
met over the life of the contract.
- Prepares a contract management profile for each Medi-Cal Plan
Partner that includes financial performance metrics, rates,
amendments, carve-outs, etc.
- Ensures the submittal of information (e.g., monthly reports,
encounters, financial, etc.), pursuant to contract terms, to Plan
Partners, DHCS and other regulatory parties are completed timely
with the most accurate and complete information available to
- Services Regional and California Statewide stakeholders
responsible for communications, assessments, identifying network
needs, strategy development, financial, implementation,
forecasting, etc. Develops strategy and leads overall
responsibilities for establishing and managing stakeholder
- Serves as the primary liaison between company CA Medi-Cal
Programs and Plan Partners to support financial reporting and data
analysis related to existing contracts, amendments, and/or ongoing
- As necessary, identifies qualified vendors to augment company
's network of non-medical services for targeted member populations.
When a vendor is engaged, leads the development of associated
contracts, vendor management, and oversight to ensure company 's
quality and resource standards are met or exceeded by our community
- Oversees the development, negotiation, implementation, tracking
and analysis of Medi-Cal Plan Partner and DHCS contract improvement
initiatives and related metrics for assessing contract
- Leads and coordinates relevant health plan, hospital, and
medical group personnel to support contract strategy negotiation,
implementation, and performance improvement metrics.
- Builds a focused, coordinated effort to build and promote
company's brand and reputation through collaboration with National,
California, SCPMG, TPMG, local Medical Centers and other KP
- Minimum ten (10) years of relevant experience in a healthcare
contract management related field, to include,
- Minimum five (5) years of leadership and management experience
in health plan, hospital and medical group administration, and
government programs (e.g., Medicare, Medicade, or Medi-Cal
- Bachelor's degree in business, finance, economics, health care
administration, or other directly related field.
- Demonstrated ability to sponsor line of business initiatives,
and lead significant organizational change.
- Significant experience working within the context of federal
and state health care laws, regulations affecting physician and
non-physician practice, facility operations, health plan
administration, political process and legislative activity,
contracting, financing and administration.
- Demonstrated success in written and verbal communication,
presentation, negotiation, public speaking, influence and
- Significant experience in developing and implementing strategic
plans, with particular emphasis in Medi-Cal and State
- Success in building and maintaining successful relations with
external governments, agencies, clients and plan partners.
- Deep knowledge of overall health plan functions, including
operations, finance, public affairs, care delivery, member
services, community benefit, claims, quality management and related
- Strong business acumen with excellent strategic and analytical
- Demonstrated strong project management skills and
- Demonstrated success in developing strong, collaborative
relationships with key leaders to achieve goals.
- Drives work through strong leadership, influencing skills and
strong healthcare knowledge.
- Must be able to work in a Labor/Management Partnership
Keywords: Kaiser Permanente, Irvine , Director, Medi-Cal Regulatory Strategy and Contracts, Executive , Irvine, California
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