Job: Consulting Services/Project/Program Management (Non IT)
Location: Regional Offices
Walnut 393 E. Walnut St.
Pasadena, CA
Scheduled Hours: 40
Shift: Day
Working Days: Mon~Fri
Schedule: Full-time
Description
Develops contracting strategies and negotiates contracts for the delivery of services provided by non Kaiser Permanente (KP) providers to KP Health Plan members. Includes accountability to develop and maintain competitive provider agreements. Works in collaboration with Region and Service Area leadership to develop and implement market and service line strategies for care provided by local community providers. Manages the contracting process in an environment of varying reliance on non KP providers. Requires alignment of KFH, SCPMG and Region and Area specific needs.
Essential Functions:
- Develops and implements competitive market and service line negotiation strategies, in
collaboration w/Regional and Service Area leadership, for delivery of health care services
to health plan members outside the KP system Conversely, on occasion is able to negotiate
contracts on behalf of Kaiser Permanente where we are the seller of health care services to
non health plan members.
- Manages a portfolio of contacts and community provider relationships for outside services
which may have a significant financial impact on the organization.
- Represents the organization as a primary business spokesperson with the community health
care providers.
- Assumes designated regional responsibility for monitoring compliance w/ contractual terms
and conditions.
- Is involved in dispute resolution Analyzes, models and negotiates financial arrangements
and business/operational terms and conditions with outside providers that meet aggressive
cost management objectives.
- Evaluates contact performance and makes recommendations to Region and Service Area
leadership with respect to new cost management opportunities.
- Participates in Region and Service Area sponsored initiatives relating to outside providers,
which may including make vs. buy analyses, options and opportunity analysis for new
contacting strategies.
- Represents the contracting department on internal task forces and committees.
- Monitors health care market place and internal utilization trends to assess new
opportunities for cost savings, alternate delivery models and financial risk sharing.
Qualifications
Experience
- N/A.
Education
- Bachelor-s degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A.
Additional Requirements:
- Significant experience in health services contacting.
- Strong negotiation skills.
- Excellent understanding of the health care industry, provider community, competitive
market strategies.
- Previous experience working with various reimbursement methodologies, financial analysis
and decision support systems.
- Demonstrated ability to work independently with a variety of internal and external
personnel at various levels of responsibility.
- Strong verbal and written communication required.
- Strong project management, leadership and facilitation skills required.
- Strong analytical skills with experience analyzing medical expenses and utilization.
- Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to
provide superior and culturally sensitive service to each other, to our members, and to
customers, contracted providers and vendors.
- Must be able to work in a Labor/Management Partnership environment.
