Job description

About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.
The Job
The Regional Contracts Manager shall, in concert with the Senior Regional Director and regional team develop and manage business partnership with SCAN contracted physician organizations, key hospitals, ancillary and supplemental providers to support achievement of SCAN’s goals including margin, quality measures, and achievement of our mission to enhance senior’s ability to manage their health and live independently.
You Will
Evaluate and negotiate contracts in a fiscally responsible manner to ensure a sustainable, high quality, compliant network for assigned region. Contracts include medical groups, IPAs, hospitals, ancillary and supplemental providers. Work with internal business units to model expected yield, monitor actual contract performance, test the feasibility of non-template terms and conditions and follows appropriate approval process.
Establish and maintain productive business relationships with SCAN’s contracted network providers, including medical groups, IPA’s, hospitals, ancillary and supplemental providers, and ensures the network composition includes an appropriate distribution of provider specialties.
Accountable for assigned provider network performance related to financial, operational, regulatory, quality and member satisfaction targets.
Develop and execute provider specific performance improvement plans, based on needs identified via Provider Dashboard metrics that highlight operational, quality, financial and compliance based measures.
Utilize contracting knowledge for effective problem resolution and compliance. Responsible for timely and professional interaction in response to contract related inquiries. Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
Participate in regularly scheduled Joint Operations Committee meetings (JOCs). These meetings will discuss operational issues relative to all parties, including, but not limited to: utilization, financial, enrollment, grievances, provider termination/panel closures, continuity of care, marketing campaigns, etc.
Responsible for assuring that the day to day operations of the provider network are consistent with SCAN standards/ expectations.
Act as technical resource on contract related issues and offer strong leadership internally as well as externally.
Participate in interdepartmental meetings and selected committees and substituting for the Senior Director, Regional Network Management on an as needed basis.
Develop goals and objectives, in concert with Regional Director, Network Management that align with the organization’s vision for future growth and network development.
Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Contribute to team effort by accomplishing related results as needed.
Other duties as assigned.
Your Qualifications

• Bachelor’s Degree, Graduate Degree in business or healthcare strongly preferred
• 5+ years managed care contracting experience required.
• Direct contracting and/or capitated delegated contracting experience
• Prior health plan experience required.
• Knowledge of CMS, DHCS and other regulatory requirements required.
• Strong analytic, quantitative, and problem-solving skills required.
• Strong negotiation, interpersonal and presentation skills with an ability to appropriately and effectively address diverse audiences required.

Covid-19 Vaccination Policy
To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting COVID-19 Vaccination Policy. Learn more about the COVID-19 vaccination here - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
What's in it for you?

• Base Pay Range: $92,400.00 to $147,800.00 annually
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
#LI-JA1
#LI-Hybrid
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
Location: Long Beach,California,90806,United States, Long Beach, CA 90806

Location: Long Beach,California,90806,United States, Long Beach, CA 90806

Job Type: Full-time

Pay: $92,400.00 - $147,800.00 per year

Application Question(s):

• Do you have direct contracting and/or capitated delegated contracting experience in a managed care setting?

Experience:

• Contract management: 5 years (Preferred)
• Contract negotiation: 5 years (Preferred)

gatheringourvoice.org is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, gatheringourvoice.org provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, gatheringourvoice.org is the ideal place to find your next job.