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Director, Health Plan Provider Contracting
- Job Title
- Director, Health Plan Provider Contracting
- Open Until Filled
- Portland, OR 97204
- Other Location
Let’s do great things, together
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
Moda Health is seeking a Director of Medical Provider Relations. This position is responsible for all aspects of provider contracting and network development for the Moda Health provider networks, including medical HMO, PPO, POS, Medicare and Medicaid in Oregon and Alaska; oversees the provider and hospital contracting process and leads network development for new networks; supports development of value based care network models, including risk based contracts and alternate payment models.
1. Works with the Vice President of Provider Strategy and Services to develop contracting and network strategies
2. Directs provider contracting with health systems, hospitals, IPA’s, individual physicians, clinics, ancillary providers, mental health, and chemical dependency providers for all Moda Health and Eastern Oregon CCO networks
3. Directs the development of new provider networks and maintenance of existing provider networks of physicians, hospitals and other providers with a focus on the development of Alaska provider networks.
4. Develops contracting strategies related to provider risk models and value based care models
5. Directs development of unit cost goals, including individual targets, and manages performance against unit cost budget, including implementation of cost containment initiatives
6. Works with Provider Analytics team to ensure provider contracts meet financial targets
7. Responsible for regulatory compliance (Medicare, Medicaid, and Commercial programs), related to provider contracts, including oversight for First Tier and delegated entities.
8. Responsible for representing Provider Contracting in internal projects and working with internal staff to resolve Provider Contracting issues and impacts, including coordinating departmental contracting and or network strategies with other departments.
9. Oversees provider rental networks and vendor relationships
10. Meets regularly with major providers to maintain ongoing provider relations.
11. Supports Value Based Care activities with providers, including interpreting risk settlements, clinical, and financial reporting related to contract models, and developing and tracking action plans to improve performance and outcomes
12. Performs other duties as assigned by the VP of Provider Strategy and Services.
Are you ready to be a betterist?
If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.
Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
- Required Skills
1. Bachelor degree in Business, Finance, or Health Care Administration or related field and 8 years of health insurance industry and supervisory experience.
2. At least 5 years of provider contracting experience in a management role
3. Understanding of physician, hospital, and ancillary provider contracts and reimbursement mechanisms, including risk mechanisms, capitation, and alternate payment models.
4. Experience with coordinated care models, ACOs, and Medicare innovation models
5. Deep understanding of provider revenue cycle
6. Ability to work well under pressure, work with frequent interruptions and handle shifting priorities.
7. Strong verbal, written and interpersonal communication skills.
8. Ability to lead, develop and motivate staff
9. Strong problem solving skills