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Network Contracting Manager
AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Network Contracting Manager has two primary responsibilities of Provider Network Development as follows:
- Planning and implementing the organization’s strategy for provider network development to assure statewide access to care for all covered benefits in a cost effective manner.
- Managing and maintaining the contracting process and the contract related activities with the organization’s prospective and existing contracted providers.
Primary Duties and Responsibilities of the Network Contracting Manager:
- Lead planning and implementation of provider network development and recruitment based on the organization’s network needs statewide.
- Develop and execute provider contracting strategies through leadership recommendations, provider proposals, comprehensive analysis, and direct negotiations of contract and compensation terms.
- Take primary responsibility for negotiation of all provider contracts that are customized for key provisions and/or compensation terms including hospitals, large provider groups and umbrella entities (ACO/IPA/IDN).
- Partner with Provider Operations leadership, Chief Financial Officer and Quality to incorporate value-based purchasing strategies (VBP) into contract templates and negotiations so as to move provider organizations further along the HCP-LAN scale.
- Work in partnership, collaboratively with Compliance, Legal counsel, Chief Financial Officer, and other departmental leaders to ensure appropriate use of provider contract templates and rate structures.
- Responsible for the development, management and maintenance of the contracting process from negotiation to contract execution, including tracking and management of the provider contracts life cycle including all amendments, addendums, exhibits, and other changes necessitated by operational and/or changes in applicable laws, and communicating updates internally and externally including the storage and retention of contract documents per AlohaCare’s guidelines.
- Supervises unit staff. Coach, train and develop staff to achieve unit goals.
- Develops/oversees department performance standards, goals, priorities and budgets.
- Responsible for communicating with other departments about network contracting related issues that may impact the organization and takes appropriate action to incorporate changes into the day-to-day operations of the unit.
- Responsible for the submission and tracking of BSS system tickets to update system reimbursements as directed by CMS and MQD notices.
- Responsible for coordinating with Provider Relations staff to support local provider recruitment, retention, education and contracting using standard templates and fee schedules.
- In collaboration with Provider Relations staff, maintain relationships with contracting staff and CFOs at facilities, large provider groups and umbrella organizations as necessary to monitor the performance of and satisfaction with current contracts.
- May represent AlohaCare at external provider related events, participate in industry work groups and/or conduct presentations to providers as needed.
- Facilitate inter-departmental collaboration for projects, process improvement and on-going operations.
- Contribute to the development of provider communications, including surveys, directories, manuals, website and newsletters.
- Support department participation in organizational efforts such as open enrollment, quality initiatives, NCQA accreditation, MQD readiness, HSAG audits and other activities.
- Monitor organizational compliance with HSAG, MQD, CMS and NCQA network access to care standards and take action to remediate any deficiencies.
- Assist with managing of production reports to fulfill contractual, regulatory and accreditation requirements.
- Communicate will all internal and external stakeholders with diplomacy, professionalism and knowledge.
- Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
Requirements of the Network Contracting Manager:
- Bachelor’s degree
- Minimum five years’ relevant work experience in a health plan setting, physician group setting or hospital setting (equivalent combination of education and experience will be considered).
- Must be able to work independently and employ strong time management and organizational skills
- Strong interpersonal communication skills, including strong written and oral communication skills
- Proven track record with provider contract negotiation
- Working knowledge of Medicaid and Medicare including fee schedules and billing procedures
- Ability to problem solve, analyze, think critically, exercise sound judgment and make fair decisions.
- Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
- Demonstrated supervisory/leadership skills, including managing remote team members.
- Advanced skills using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
- Requires operation of general office equipment to include; PC, fax/copy machine and ACD Mitel Phones.
- Valid driver’s license and access to an insured car.
Preferred Requirements of the Network Contracting Manager:
- Public speaking experience
- Financial analytical skills to discern financial and performance risks
Mental, Physical and Environmental Demands:
- Ability to travel inter-state with occasional overnight stays.
- Available to work evenings and some weekends
- Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
- Inside working conditions
- No environmental hazards
- Requires operation of general office equipment to include Network and Computer
Salary Range: $85,000 – $100,000 annually
Signing bonus: $5,000 paid out one (1) year from hire date.
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.
Job Title: Accounting/Human Resources Manager
Reports To: President and CEO
FSLA Status: Exempt
Work Schedule: Full Time; 24-hour Administrative Call
Supervises: Finance/Human Resource Coordinator, Administrative Services Coordinator/Data Manager
The Accounting/Human Resources Manager is responsible for accounting, finance, human resources, and general office management of the organization.
Under the general direction and supervision of the President and CEO, and in accordance with
established standards, policies and procedures, the Accounting/Human Resources Manager
performs duties as assigned including, but not limited to the following:
1. Accounting and Finance
a. Plans, directs, and coordinates all accounting functions.
b. Provides timely and accurate management information, reports, and analysis.
c. Ensures that accounts are reconciled monthly and financial statements reflect Generally Accepted Accounting Principles (GAAP).
d. Oversees all aspects of payroll including efficient and effective payroll processing.
e. Coordinates all aspects of the annual financial audit.
f. Performs reasonableness tests and financial analysis of operations.
g. Prepares the annual budget.
h. Evaluates accounting and internal control systems.
i. Improves the current process and implements new processes.
j. Develops an monitors business performance.
k. Oversees all regulatory reporting, including tax planning and compliance.
l. Tax compliance including W-2/1099s, 990T/UBIT, General Excise, Form 5500, Real Property Tax exemption, tax clearance forms, unemployment, UC-B6.
m. Cost accounting including preparation of annual cost report and cost report monthly estimates.
n. Initiates, reviews and maintains appropriate internal controls to ensure proper accounting procedures and protection of assets.
2. Human Resources
a. Oversees all human resource functions and processes including hiring, onboarding/offboarding, initial and recurring OIG review, attraction and selection, performance reviews/management, wage and hour and other regulatory compliance, compensation system (grades/ranges, adjustments), employee benefits management (life insurance, other benefit testing, 403b plan, flex spending, etc.), employee engagement, conflict resolution/grievance,
HEC/AOPO/other surveys, training, OSHA/injury reporting, personnel file maintenance, unemployment/workers compensation coordination, 404b (employer/employee records, plan testing, government reporting, year-end census, contribution processing, participant distribution/loans, rollovers, annual/monthly contribution), flex spending and other annual testing. Manages, reviews, and responds to unemployment and workers’ compensation claims.
3. Office Management
a. Leads direct reports in accordance with Legacy of Life Hawaii leadership standards and principles.
b. Responsible for management of office equipment, building issues, security system, and overall office management.
c. Development, review, and implementation of accounting, finance, human resources, and office management policies.
d. Review and management of all Legacy of Life Hawaii contracts.
4. Regulatory Compliance
Monitors compliance of organizational and departmental policies with standards and guidelines of UNOS, AOPO, CMS, FDA, OSHA, state, federal, and other governmental / regulatory agencies, and with industry standards. Conducts an annual review of Administrative, Finance, IT and Human Resource policies and procedures.
5. Twenty-four hour availability to assist staff and/or the public with questions and/or problem solving.
6. Performs other related duties and assignments as required.
- Minimum Education / Training / Licensure
Bachelor’s degree in business, accounting or equivalent relevant experience. Strong administrative and / or fiscal background required. Must possess a current driver’s license recognized by the State of Hawaii and have an insured motor vehicle.
- Preferred Education / Training / Licensure
Bachelor’s degree in business, management or related field. Three to five years experience in management preferred.
- Knowledge, Skills and Abilities
A firm grasp of Generally Accepted Accounting Principles required. Strong information technology/computer skills required. Significant wage and hour, human resources knowledge preferred.
- Working Conditions / Environment
Works primarily indoors; working evenings, weekends and holidays may be required to perform the tasks outlined in the job description. Travel by personal automobile to Oahu hospitals, events or Honolulu International Airport for travel to neighbor island hospitals or events by charter or commercial aircraft. Work requirements may extend beyond a 24 hour shift with few breaks.
- Physical / Mental / Special Demands
Physical demands: Majority of duties entail sitting, standing, walking, reaching occasional climbing, stooping and kneeling. Visual and auditory acuity within normal range required. Duties require manual and finger dexterity; eye/hand coordination with
depth perception. Requires full range-of-body motion; occasionally lifts/carries or pushes/pulls items weighing in excess of 75 pounds, with assistance when needed.
Mental demands: Duties require attention to detail, concentration, and alertness. Effective problem solving, tact, courtesy, accepting and carrying out responsibilities for decision making and planning. Requires assimilating data and formulating sound and effective assessments, conclusions and judgments. Must be self-directed, assertive, and resourceful.
Communication demands: Strong interpersonal skills and the ability to communicate effectively with a wide range of people. Duties require frequent verbal communication with staff, donor families, surgeons, other physicians, other healthcare providers, media, fund development sources, legislators, financial institutions, and government agencies. Must be able to effectively communicate, orally and in writing, ideas, facts, instructions and information clearly and concisely. Frequent reading and writing required. Fluency in English (read, write, speak) with strong verbal and written communications skills required. Education and/or public speaking experience desirable. Must be able to communicate large amounts of complex information, over the phone and in person, in a chaotic and fast-paced environment.
Interested individuals should submit their resumes to [email protected]. Please include position title, Accounting Human Resources Manager, in the email subject line.