Regional Contracts Manager

The Job

The Regional Contracts Manager shall, in concert with the Senior Regional Director and regional team, develop and manage business partnerships with SCAN contracted provider partnerships, delegated medical groups, IPAs, health systems, and hospitals to support achievement of SCAN’s financial performance, member experience, quality outcomes, and long-term growth. Working closely with Provider Relations and cross-functional leaders, this role plays a critical part in advancing SCAN’s mission to keep seniors healthy and independent.

• Serve as support negotiator for high-impact agreements across delegated medical groups, IPAs, hospitals and integrated delivery systems.
• Work with internal business units to model expected yield, monitor actual contract performance, test the feasibility of non-template terms and conditions, and follow appropriate approval process.
• Act as technical resource on contract related issues and offer strong leadership internally as well as externally.
• Review, analyze, and redline contract documents in accordance with organizational standards, risk tolerance, and contractual objectives, applying sound professional judgment to negotiate and resolve terms.
• Accountable for assigned provider network performance related to financial, operational, regulatory, quality and member satisfaction targets.
• Establish and maintain productive business relationships with SCAN’s contracted network providers, including medical groups, IPA’s, hospitals, and integrated delivery systems.
• Partner with actuarial, finance, and operational teams to evaluate financial and operational implications of contract strategies.
• 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.
• Navigate non-standard and complex deal structures, balancing financial performance, compliance, and long-term partnership value.
• Ensure that the day-to-day operations of the provider network are consistent with SCAN standards/expectations.

Your Qualifications

• Bachelor's Degree or equivalent experience.
• 5 years managed care contracting experience with complex provider organizations.
• 2-3 years of leadership experience.
• Knowledge of CMS, DHCS and other regulatory requirements related to delegated risk.
• 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.
• Technical expertise - Advanced technical skills for functional area.
• Advanced Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook, Teams), and SQL are required.
• Problem Solving - Strong problem solving skills.
• Communication - Excellent written and verbal communication and interpersonal skills.

What's in it for you?

• Base salary range: $92,400 to $133,671 per year.
• Internal title: Regional Contracts Mgr.
• Work Mode: Mostly Remote.
• An annual employee bonus program.
• Road Robust Wellness Program.
• Generous paid-time-off (PTO).
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
• Excellent 401(k) Retirement Saving Plan with employer match and contribution.
• 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!