Contract Manager
Community Care Plan - Sunrise, FL
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Position Summary The Contract Manager is responsible for managing and ensuring contractual compliance of Community Care Plan's assigned contract(s) through effective communication and coordination with other functional areas. Essential Duties and Responsibilities: * Establish and maintain collaborative working relationship with assigned client and other key industry stakeholders; serve as primary liaison per contract requirements; provide accurate, timely and concise replies to requested data or reports, etc. * Primary liaison to provide interpretation and guidance to the organization regarding contract requirements and administration. * Analyze, summarize, and guide the implementation of the annual and interim contract amendments in conjunction with appropriate business owners. * Ensure effective implementation of new and renewing contracts through communication and coordination with other functional areas. * Coordinate and compose time-sensitive responses to incoming regulatory requests and inquiries/issues reflective of compliance with contract requirements. * Coordinate & participate in audits and site visits by client, as per contract. * Develop and maintain relationships with key internal and external stakeholders to ensure successful collaboration. * Identify and recommend performance improvement opportunities. * Report potential risks, non-compliance, or alleged contract violations. * Engage in Quality Management Initiatives including, but not limited to, material approval, complaints, and grievances, etc. (when applicable) * Develop and present Quarterly Performance Measures report to client (when applicable). * Liaison between client, providers, and Community Care Plan corporate office. * Assist providers regarding claims inquiries, authorization status, network status etc. * Serve as the liaison for resolving issues with Community Care Plan's internal depts, e.g., Medical Economics, Claims, Provider Operations, IT, UM, etc. * Travel for presentations, account satisfaction functions, etc., when required This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Skills and Abilities: * Proficient in Microsoft Word, Excel and PowerPoint * Knowledge of regulatory environment * Experience in a high-growth business environment * Working knowledge of health plan policies and procedures * Strong analytical and statistical skills * Ability to work in a fast-paced environment and reprioritize * Effective problem-solving skills with attention to detail * Ability to develop, prioritize and accomplish goals * Strong communication skills (both written and verbal) * Strong interpersonal skills & high level of professionalism * Ability to work independently and within a team environment * Effective active listening and critical thinking skills * Display a customer service, member-focused orientation Work Schedule: As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *The company reserves the right to change the work schedules based on the company needs. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion. Qualifications * Must have a Bachelor of Science/Arts in Business or other degree in a related medical or business field or equivalent years of experience is required * Business Administration (MBA) or Management is preferred * Three to five (3 to 5) years in a Managed Care Organization; or other healthcare related field is preferred
Created: 2024-07-07