Health Plan Operations Manager, Contracts and Credentialing
US
Health Plan – Health Plan Operations /
Full-time /
Remote
About this Role
This role presents an exciting opportunity for a mission-driven individual to play an integral role in the oversight and management of contracting and credentialing process of our vendor and provider network partnerships for our integrated care delivery startup. This teammate will report to the Senior Director of Health Plan Operations and will be responsible for managing, scaling, and continuously improving our compliance around contracts and credentialing while supporting the Vendor & Network Operations role in oversight of the existing partnerships. The role will lead the continued development and improvement of the myPlace Health contract management life cycle and credentialing to meet the PACE standards and specifications within State and Federal contract. This team member will also maintain a highly organized contract repository and tracking system to monitor ongoing credentialing. As one of the inaugural members of our health plan operations team, this leader will set the tone in how we develop sound, compliant, and efficient health plan operations that enable us to scale our model effectively and responsibly.
Expectations for this Role
- Leads end-to-end contracting process in support of relationships and collaborations with our network of care partners and providers
- Maintains template contract agreements and makes updates as needed
- Maintains provider network listings to ensure accuracy and completeness
- Coordinates all credentialing activity with contracted vendors and maintains a centralized system for tracking credentialing
- Ensures contract compliance and credentialing compliance with State and Federal regulations.
- Partners with Quality and Compliance team on the establishment of mock audits in preparation for future State and CMS audit readiness
- Addresses and negotiates, as needed, single-case agreements or letter of agreements
- Supports Network & Vendor Operations through the management our catalog of contracts, properly loading all contracts into required systems/vendors, and delivering new vendor/provider onboarding
- Supports Network & Vendor Operations, IT, Finance and other key departments with procurement, vendor management and tracking of various contract types
- Analyzes risk management data with the objective of identifying and controlling loss to protect the assets of the organization.
- Assists the Quality & Compliance Director Improvement Manager/Compliance Officer to coordinate quality assessment of providers including onsite visits of providers
- Ensures that applicable websites are monitored monthly and as needed for disciplinary summaries from the Board of Medical Examiners, as well as excluded providers from Medicare and Medicaid (OIG)
- Implements a regular standing meeting with key contract owners at the time of renewal to evaluate performance and contract continuance.
- Develops structure for contract repository system to manage all executed agreements with quality controls in place to ensure all contracts are up to date and tracked.
- Develops policies and procedures that meet applicable PACE program requirements
- Stays current on regulations and policies impacting the PACE program, health plan operations, and our compliance program and share that knowledge across the organization
- Assist the company in ad hoc special projects, including collaborations with external partners, vendor contracting, and other operating model decisions
- Seeks continual improvements to processes and systems across functions as the size and complexity of our business grows
- Communicates confidently and persuasively to all audiences, including external stakeholders
Attributes of an Ideal Candidate
- Passion and mission orientation for serving high-risk seniors and frail older adults
- Strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization
- Thrives in a relatively undefined, “zero to one” environment – unafraid to “roll up your sleeves” and drive a wide-ranging set of projects, processes, and deliverables
- Preferred 5+ years of related experience in a similar role and education concentration (e.g., certification, Bachelor’s, or Master’s) in a related field (e.g., business, legal, healthcare administration/MHA, etc.)
- Meticulous attention to detail – ability to review contracts for discrepancies
- An independent worker who can run down problems with relatively little direction, knows when and how to escalate effectively
- Prior experience building from the ground up a contract management function at a high-growth healthcare organization preferred
- Expert proficiency in both MS Excel and PowerPoint required
Location
- Remote with ability to travel 20-40% based on business need
- Relocation benefits offered if willing to reside in Los Angeles metro areas
$85,000 - $125,000 a year
myPlace Health offers a robust compensation package for this role that includes cash compensation and other total rewards. Base pay is based on several factors including but not limited to education, relevant work and industry experience, certifications, and location of the role. Onsite roles include appropriate geographic adjustments, while remote roles are typically priced off national pay data.
This role is eligible for the following:
Performance-based cash bonus.
401k with Employer match
Your choice of 6 medical plans, with premium coverage of up to 80% for employees and 75% for all dependents
Dental, vision, health savings account, flexible spending accounts, short- and long-term disability coverages
PTO starting at 20 days per year; plus 12 paid holidays per year, and 2 floating holidays per year
Generous CME/CEU budget and time off, and professional development opportunities
One-time stipend towards setting up your home office (for remote or hybrid roles)
Family friendly policies, including paid new parent leave!
