Career Center

The overall purpose of the Provider Contract Manager 2 position is to effectively manage an assigned portfolio of NWP, KFH and KFHPNW contracted provider relationships in a manner consistent with (1) NWP's objectives, (2) KFH and KFHPNW's objectives, (3) NCQA, JCAHO, and other accreditation requirements, (4) applicable federal and state laws and regulatory requirements, (5) meets the Care Delivery needs of KFHP-NW's Members, and (6) upholds the business, finance, regulatory and reputational interests of KPNW.

Join our medical group

Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.

Major Responsibilities / Essential Functions

Network Development

• Identifying contract options and targeted providers
• Establishing short- and long-range contractual terms
• Developing pricing models across multiple facilities, service lines, service levels and programs
• Maximizing contract leverage
• Preparing reports on the cost of contracted services
• Identifying trends and then using a team-based approach to evaluate options for change

Contract Performance

Contract Compliance

Minimum Education

• Bachelor's degree or equivalent experience in business, finance, healthcare administration or related field.

Minimum Work Experience

• Minimum three (3) years progressive responsibility and quantifiable results in network development and delivery system negotiations, with experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
• Strong influencer; demonstrated contributor to building and upholding a positive team culture.
• Strong financial acumen - must possess extensive knowledge of hospital, physician, skilled nursing, and ancillary provider reimbursement models for commercial and government payers, including pay for performance models.
• Knowledge of network development, provider network clinical and business operations, provider relationship management, reimbursement analysis, contract performance analysis.
• General knowledge of legislative and government activities and marketplace issues affecting the region preferred.
• Comprehensive knowledge of Medicare and Medicaid payment methodologies, level of care pricing, and federal and state health care regulations.
• Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiations, interpersonal relations, oral and written communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation and project management.
• Must be a "self-starter" with a strong sense of initiative and follow-through. Ability to work independently under high-pressure circumstances with little or no supervision.
• Software skills including Microsoft Word, Excel, PowerPoint, Access, Project, and Visio preferred.

Additional Requirements

• Budget Responsibility: The Provider Contract Manager has no direct KPNW operating budget responsibility, per se, since the contracts contemplate services that are part of the overall budget responsibility of a NWP Service Chief/Practice Director or a KFHP Operations Leader (e.g. the Director of Continuing Care Services). It should be noted, however, that the Provider Contract Manager has significant influence on KPNW's operating budget in their ability to negotiate cost-effective financial terms and payment strategies.
• Ability to negotiate cost effective contracts to meet operating budget targets in an environment where KPNW holds little to no leverage, and provider relationships are challenged due to KPNW's internalization and integrated care delivery strategies.
• Ability to meet operating budget targets.
• Able to handle the constant pressure of multiple simultaneous projects with competing priorities and deadlines.
• Due to the demands placed upon the Provider Contracting Department, the pace is rapid and dynamic, sometimes causing project priorities to rapidly and significantly shift. Ability to work in a high pressure environment with sometimes limited resources while expected to meet aggressive project timelines.