Under direction, to plan, organize, manage and coordinate contracts and program activities for Managed Care and Valley Health Plan, etc. Incumbents interface with County Counsel, Patient Business Services, Professional Group, and the Board of Supervisors and serve as a liaison for Valley Health Plan.
This recruitment requires the submission of an online application. No paper applications will be accepted. Applicants must apply online at www.sccjobs.org. Computers are available at the County Government Center, 70 West Hedding Street, 8th Floor, East Wing, San Jose, CA 95110, during normal business hours, for applicants to apply online.
All applicants are required to complete the supplemental questionnaire. Applications received without the completion of the supplemental questionnaire will be rejected.
Benefit and Retirement information may vary from bargaining unit to bargaining unit. Due to changes in State Law, current pension provisions described in the union contracts are not automatically applied. Specific pension benefits for new hires who start on or after January 1, 2013 may be different than indicated in the union contracts.
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all Memoranda of Understanding and most recent Summary of Changes.
Reviews contracts from multiple entities desiring to contract hospital or physician services from Santa Clara Valley Health & Hospital System;
Performs program and cost analysis and market research on a variety of hospital, clinic, medical group and health related projects as needed and on an on-going basis;
Develops and negotiates commercial and Medi-Cal contracts with HMO's, PPO's, clinics, and physicians groups for Valley Medical Center (VMC), and VMC physicians; Medi-Cal Managed Care contracts and specialty referral and ancillary contracts on behalf of Valley Health Plan; business development contracts with other community providers for VMC;
Negotiates all rates/reimbursements for all commercial hospital and physician services;
Develops and negotiates terms and conditions for all commercial contracts including health plans, medical groups, and third party payors;
Performs cost analysis of inpatient and outpatient hospital and physician services;
Coordinates with various hospital departments to ensure contract compliance including utilization management, case management, claims, billing, admitting, and finance;
Identifies revenue producing opportunities for hospital and physician group within healthcare community;
Acts as primary contact/liaison for operational problem between hospital departments and health plans;
Provides in-service training to other departments relative to contract implementation;
Acts as a resource for departments at Valley Medical Center regarding managed care contract interpretation;
Serves on inter-departmental committees on a regular basis and ad-hoc basis for contracting, planning, and marketing related activities;
Prepares and submits transmittals related to delegation of authority, contracts review, office leases and other actions that require approval from the Board of Supervisors;
Prepares Request For Proposals for vendor selection for SCVH&HS and other county agencies;
Facilitates the selection process of outside vendors and negotiation and preparation of contracts with such vendors;
Develops responses to Request For Proposals from insurers, other health care providers, other county agencies and other entities;
Coordinates any required interdepartmental response regarding Request For Proposals and interfaces with County Counsel and outside counsel on related legal issues;
Assists the Director of Planning and Marketing in administrative activities and responds to numerous internal and external inquiries for information regarding SCVH&HS services;
Identifies program problems, determines appropriate action and makes recommendations for problem resolution; assists in the implementation of program enhancements and service improvements;
Analyzes and interprets existing, new and proposed legislation for cost and program impacts;
Sufficient education and experience which directly demonstrates the possession and application of the following knowledge and abilities:
The knowledge and abilities required to perform this function are typically attained through training and experience equivalent to a Bachelor's degree from a college or university in health care administration, public administration or a related field AND four years of professional level analytical or administrative experience, two of which must be in a health care setting. A Master's degree in one of the disciplines listed above may be substituted for one year of the non-health care experience.
Principles and practices of health care delivery systems and the issues shaping the health care industry;
Strategic planning in a health care setting;
Contracting principles, including contract evaluation and monitoring related to health care administration, and health plan and hospital operation;
Health care and Managed Care regulations at Federal, State, and local levels;
Insurance industry practices and healthcare payment mechanisms;
Current Managed Care information systems issues including enrollment and billing systems, utilization/authorization management and management reporting systems;
Trends and policies that affect healthcare;
Health care cost structure and cost analysis, healthcare and managed care financing/reimbursement principles;
Statistical analysis and techniques including computer based statistical programs;
Current legislation and trends in government policy that affect health care providers.
Analyze health care utilization and financial implications;
Administer and monitor contract performance;
Direct and coordinate other department staff in resolving operations issues;
Develop business relationships and alliances with community providers;
Develop and write policies, procedures and projections;
Formulate, gather, analyze and present financial, informational and statistical data;
Evaluate program information and reach valid conclusions;
Communicate clearly and effectively with the public, agency staff and health care professionals at all level;
Establish and maintain effective communication with management, other health agencies/providers, and the general public;
Represent SCVHHS on assigned committees and with service providers.
Veterans Preference Information
This recruitment has been identified as non-entry level by the Human Resources Director. Any veteran who has submitted a copy of their DD214 form, and received an honorable discharge within the last five years, will be given a preferential credit of five percent (ten percent for those identified as disabled veteran’s), after attaining a passing examination score for a numerically scored examination.