Manager, Managed Care & Pharmacy Contracts - Military Veterans

Manager, Managed Care & Pharmacy Contracts

Job Summary

#CA-DK

The incumbent works independently and proactively with decision-making responsibility under the general oversight and direction of the UCDH Managed Care & Pharmacy Contracts Director; assists department/division leadership with and/or independently drafts, negotiates, oversees, coordinates and processes Department's payor and provider contracts with professional, facility, pharmacy and ancillary payor and provider contracts with 'managed care' payors including: HMO/PPO health plans/payors, insurance companies, third party administrators, payor/specialty networks and external providers.

Incumbent will be responsible for drafting original and change' documents, reviews and edits proposed documents and administers/implements all such contractual transactions during the in-force life of the arrangement. The incumbent serves as a resource for UCDH staff and others to provide information, interpretation, and training regarding the financial and operational terms of the contracted arrangements through a variety of means.

The role is responsible for cooperation and coordination with all impacted UCDH managed care and non-managed care operational or functional areas. The incumbent performs researches through a variety of means, evaluates, implements and incorporates into contracts changes in federal and/or State law and University policy related to health care contracting. This role will negotiate and manage payor, pharmacy and health plan contracts responsible for system revenue in excess of $2 billion.

Apply By March 10, 2025 at 11:59 pm

Minimum Qualifications

For full consideration, applicants are encouraged to upload license and/or certification if required of the position

• Bachelor's degree in business or related field and/or an equivalent combination of education, training, and experience.
• Advanced experience and knowledge pertaining to managed health care programs, products, operations and policies
• Extensive experience preparing and negotiating complex managed care payor and provider contracts documented and advanced experience negotiating hospital, medical group, ancillary, pharmacy and/or downstream agreements in a health care provider setting and/or a health care payor setting
• Extensive experience preparing and negotiating complex managed care payor and provider contracts with documented experience negotiating hospital, medical group, ancillary, pharmacy and downstream agreements in a health care setting and/or payor setting.
• Advanced ability to communicate in writing In a clear, concise and professional manner, via email, letter, and contract documents with the ability to interact with a wide variety of individuals and groups in the healthcare private and public sectors, government, non-profit organizations, and educational institutions, as well as with UCDH faculty and staff.
• Advanced ability to exercise personal initiative and direction, to maintain a sense of self-confidence sufficient to enable Incumbent to accept responsibility for decisions, attempt difficult or unfamiliar tasks, develop new sources of information, present recommendations persuasively, and to provide/receive advice effectively
• Advanced ability to make sound decisions and recommend appropriate strategies and resolutions to department management based upon knowledge and data
• Operating knowledge and skills necessary to utilize current widely utilized and accepted business and healthcare system applications such as MS 365, Word, Excel, SharePoint, Teams, Adobe, meeting Apps, EPIC, etc.
• Advanced critical-thinking, problem-solving, and project-management skills to effectively manage and prioritize multiple levels of information and responsibilities, to successfully manage projects from inception to completion, and to independently assess complex problems and develop an expedient path of resolution.
• Advanced detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts and effectively carry out all contracting activities.