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Director, Medi-Cal Regulatory Strategy and Contracts

Company: Kaiser Permanente
Location: Irvine
Posted on: September 13, 2020

Job Description:

We're looking for a candidate to fill this position in an exciting company.

  • 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 capabilities.
  • 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 company.
  • 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 relationships.
  • 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 contract negotiations.
  • 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 partners.
  • Oversees the development, negotiation, implementation, tracking and analysis of Medi-Cal Plan Partner and DHCS contract improvement initiatives and related metrics for assessing contract performance.
  • 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 departments.
  • 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 experience).
  • 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 collaboration.
  • Significant experience in developing and implementing strategic plans, with particular emphasis in Medi-Cal and State Programs.
  • 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 regulatory services.
  • Strong business acumen with excellent strategic and analytical thinking capacity.
  • Demonstrated strong project management skills and implementation expertise.
  • 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 environment.

Keywords: Kaiser Permanente, Irvine , Director, Medi-Cal Regulatory Strategy and Contracts, Executive , Irvine, California

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