Network Manager in Georgia
The primary function/responsibility of the Network Manager will be to support the contracting activities of the Medical Group and Health Plan. Contracting activities continue to grow substantially in volume, financial impact and complexity. Existing contracts must be continually renegotiated and aggressively managed. The Network Manager position is expected to manage outside medical cost for the Kaiser Permanente Health Plan through contracting initiatives, analysis of financial reports and trends in the marketplace. Areas of responsibility will include IPA´s, PHO´s, hospitals and key specialty services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; and a miminum of 5-7 years of negotiation in hospital, PHO/IPA and various high volume services.The minimum requirements for the successful candidate will be:• BS/BA in Business Administration, Finance or Healthcare • MBA or MHA preferred • 7-10 years experience in Health Care Administration, Managed Care Contracting or Health Care finance a plus • Must possess a successful track record of negotiating large hospital system contracts • Ability to budget and obtain necessary medical cost targets • Strong understanding of financial reports and the ability to manage accordingly • Must understand contract language and legal requirements for contracting • Strong understanding of State and Federal Laws related to provider contracts • Strong understanding of Medicare contracting and reimbursement methodology • Broad based knowledge of healthcare and the various medical delivery systems • Understanding of various financial reimbursement methodologies used in managed care contract is required- CMS DRG´s, Revenue Codes, APC´s, RBRVS and ASC Groupers • Negotiation and analytical skills are necessary • Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity are required • Strong written and excellent communication skills • Management skills required with the ability to manage a team of field representatives • Strong presentation skills • Ability to interact with senior leadership team and provide recommendations on contract strategies and cost • Expert knowledge of Excel, Access, Power Point and Contract Management system • Strong Project Management skills