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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

Under the general direction of the Director, Managed Care, the Senior Specialty Contract Manager, is responsible for negotiation and management of designated payer and pharmacy benefit manager (PBM) agreements on behalf of Stanford Health Care, Stanford Medicine Children's Health, Stanford Medical Partners, Packard Children's Health Alliance, and other applicable entities in support of the department's strategic goals and objectives. Provides managed care contract implementation and operations support, together with interpretation of assigned contracts to internal and external partners.

Locations

Stanford Health Care

What you will do

• Negotiates contract language and reimbursement, for primarily transplant, high-cost drug, and specialty pharmacy contracts and letters of agreement, that are consistent with SHC/SMCH financial and legal guidelines and overall managed care strategies.

• Prepares, analyzes, and interprets financial reporting and modeling in support of contract negotiations.

• Develops and implements strategies to access performance of various contract types, including but not limited to transplant, high-cost drugs, and specialty pharmacy contracts.

• Sustain a deep understanding of managed care principles, a proactive approach to problem-solving, and a commitment to optimizing contracting outcomes.

• Maintains a thorough operational knowledge of contractual agreements and specific contractual language.

• Negotiates and implements varied and complex reimbursement methodologies.

• Collaborates closely with applicable service line administration and Revenue Cycle to ensure compliance with the terms of assigned agreements.

• Develops and maintains strategic relationships with internal personnel, payers and PBMs, at all levels of authority.

• Identifies, evaluates, and makes recommendations related to managed care operational and payment issues.

• Responds to physician, pharmacy, and administrative concerns relative to contract pricing, cost, managed care, etc.

• Represents the department within interdepartmental meetings and committees regarding operational and educational issues related to managed care.

• Research new and emerging therapies/technologies that impact assigned contracts.

• Build and maintain collaborative relationships with SHC/SMCH Pharmacy, Transplant Administration, Finance, Revenue Cycle, etc.

Education Qualifications

• Bachelor's degree in a work-related discipline/field from an accredited college or university

Experience Qualifications

• Five (5) years of progressively responsible and directly related work experience within Managed Care. Pharmacy and/or Transplant contracting experience preferred

Required Knowledge, Skills and Abilities

• Ability to persuade, negotiate, or influence others.

• Ability to use complex mathematical calculations.

• Ability to meet tight deadlines and adapt to an ever-changing business environment.

• Ability to assess both internal and external requirements and reprioritize quickly.

• Ability to oversee multiple projects simultaneously.

• Strong knowledge of medical and/or pharmacy claims processing, coding and billing practices.

• Ability to mediate and resolve complex problems and issues.

• Knowledge of computer systems and software used in functional area.

• Strong analytical skills and financial analysis experience including strong experience with Excel, Word, and PowerPoint.

• Knowledge of new technologies (in specific field) and maintain and stay abreast of updates and changes.

• Previous experience in Managed Care contracting with preferred experience in transplant and/or pharmacy contracting.

• Excellent verbal and written communication skills.

• Excellent customer service, organizational, and presentation skills.

• Excellent analytical and critical thinking skills.

• Proficiency in spelling, punctuation, and grammar with the ability to prepare concise written reports to a variety of audiences.

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $52.64 - $69.74 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .