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Director of Contract Management

Director of Contract Management

Pinnacle Treatment Centers, Inc.Mount Laurel, NJ, US
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Job Description

Job Description

Director of Contract Management

We offer competitive salaries, full benefits package, Paid Time Off, and opportunities for professional growth.

Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 35,000 patients daily.

Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works.

Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment.

As the Director of Contract Management, you will manage all aspects of the contract lifecycle, provide oversight of the contract management process, and ensure consistent management of all Pinnacle Treatment Centers payor contracts. You will be responsible for evaluating, analyzing, negotiating, and implementing new payor contracts, negotiating the renewal of existing payor contracts, and monitoring contracts in place. You will also work with many internal stakeholders, including the Senior Director of Payor Operations and Analysis, to utilize financial models and analysis in negotiating rates with payers.

Benefits :

  • 18 days PTO (Paid Time Off)
  • 401k with company match
  • Company sponsored ongoing training and certification opportunities.
  • Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance.
  • Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP)
  • Discounted tuition and scholarships through Capella University

Salary

  • $120,000 - $140,000
  • Bonus eligible

    • Requirements :

  • Strong record of success as an emerging leader in a complex, matrixed environment
  • Demonstrated record of accomplishment of building strong working relationships across internal constituents (e.g., market and regional P&L and operational leaders) and external constituents (e.g., private payors such as UHC, BCBS and Humana)
  • Bachelor’s degree, preferably in Business or related Healthcare administration required
  • Minimum of 10 years in progressive roles in payor and / or provider organizations required
  • Demonstrated analytical, project management, and leadership skills
  • Sound understanding of provider revenue cycle, payor enrollment and credentialing, and materially impactful contract language
  • Experience in network management and / or payor contracting
  • Knowledge of value-based contract methodologies and preferred financial and administrative terms
  • Ability to think independently and develop new processes and analyses as required
  • Valid driver’s license in good standing
  • Ability to travel up to 20% as needed including overnight travel

    • Preferred

  • Master's degree in business or healthcare administration or additional experience can substitute for an advanced degree
  • Knowledge and understanding of health plan network operations
  • Substance Use Disorder segment experience

    • Responsibilities : Contracting

  • Develops and maintains strong payer relationships. Serves as primary organizational contact and as a communication link between payers and Pinnacle.
  • Identifies appropriate contracting and re-contracting opportunities, which include but are not limited to :
  • Health Insurance plan offerings such as Commercial, Commercial Exchange, Medicare Advantage
  • Medicaid (Managed Care Organizations) MCOs, Medi-Cal
  • Independent Physician Associations (IPAs) and Primary Medical Groups
  • Works with the Senior Director of Payor Operations and Analysis and the Finance department to perform business and market analyses to determine viability of contracting and to develop new and renewal rate proposals
  • Leads negotiation of contract terms with payers to maximize reimbursement and long-term value of contract.
  • Works with the Senior Director of Payor Operations and Analysis, the Finance department, Revenue Cycle Management, Quality Assurance, Operations, and legal counsel to review proposed contract language and terms to ensure regulatory compliance with state regulations.
  • Communicates with internal parties to ensure contractual terms, including payer-specific requirements, are understood. Serves as expert on all terms of the payer contract.

    • Contract Performance

  • Monitors contract performance to ensure compliance with terms.
  • Collaborate with the Senior Director of Payor Operations and Analysis, and the Finance department to assemble relevant data and assess financial and operational aspects of payer performance.
  • Interfaces with the Revenue Cycle team to identify contractual conflicts or changes requiring escalation, communicates issues internally with appropriate parties, and leads review and resolution.
  • Communicates all contract changes internally.
  • Identifies issues and opportunities in contract renewal process.
  • Provides support for assessment of quality-of-care indicators and clinical outcomes.
  • Facilitates ongoing dialog between Pinnacle and payor clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and Readmissions

    • Market

  • Research, analyze, and reports on the healthcare market and regulatory environment to identify contracting opportunities and risks and maintain awareness of competitor activity.

    • Contract Management

  • Works with the Senior Director of Payor Operations and Analysis and legal counsel to develop corporate standards for contracts, including payment terms and legal provisions.
  • Ensuring payer contracts are centrally maintained and organized.

    • Other

  • Provides support for assessment of quality-of-care indicators and clinical outcomes.
  • Facilitates ongoing dialog between Pinnacle and payer clinical and medical teams for improved outcomes including, but not limited to, decreased denied days and readmissions.
  • Other duties as assigned

    • Join our team. Join our mission.

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    Director Contract Management • Mount Laurel, NJ, US

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