Health Care Services Business Developmen... - County of Santa Clara - Santa Clara, CA

Health Care Services Business Developmen... - County of Santa Clara - Santa Clara, CA -

Beneath course, to plan, arrange, handle and coordinate contracts and program actions for Managed Care and Valley Health Plan, and so on. Incumbents interface with County Counsel, Affected person Business Services, Skilled Group, and the Board of Supervisors and function a liaison for Valley Health Plan.

Typical Duties:
Evaluations contracts from a number of entities needing to contract hospital or doctor providers from Santa Clara Valley Health & Hospital System;

Performs program and price evaluation and market analysis on a spread of hospital, clinic, medical group and well being associated tasks as wanted and on an on-going foundation;

Develops and negotiates business and Medi-Cal contracts with HMO’s, PPO’s, clinics, and physicians teams for Valley Medical Middle (VMC), and VMC physicians; Medi-Cal Managed Care contracts and specialty referral and ancillary contracts on behalf of Valley Health Plan; enterprise improvement contracts with different group suppliers for VMC;

Negotiates all charges/reimbursements for all business hospital and doctor providers;

Develops and negotiates phrases and circumstances for all business contracts together with well being plans, medical teams, and third celebration payors;

Performs value evaluation of inpatient and outpatient hospital and doctor providers;

Coordinates with numerous hospital departments to make sure contract compliance together with utilization management, case management, claims, billing, admitting, and finance;

Identifies income producing alternatives for hospital and doctor group inside healthcare group;

Acts as main contact/liaison for operational drawback between hospital departments and well being plans;

Supplies in-service coaching to different departments relative to contract implementation;

Acts as a useful resource for departments at Valley Medical Middle relating to managed care contract interpretation;

Serves on inter-departmental committees regularly and advert-hoc foundation for contracting, planning, and marketing associated actions;

Prepares and submits transmittals associated to delegation of authority, contracts evaluate, workplace leases and different actions that require approval from the Board of Supervisors;

Prepares Request For Proposals for vendor choice for SCVH&HS and different county businesses;

Facilitates the choice course of of outdoors distributors and negotiation and preparation of contracts with such distributors;

Develops responses to Request For Proposals from insurers, different well being care suppliers, different county businesses and different entities;

Coordinates any required interdepartmental response relating to Request For Proposals and interfaces with County Counsel and out of doors counsel on associated authorized points;

Assists the Director of Planning and Advertising in administrative actions and responds to quite a few inner and exterior inquiries for info relating to SCVH&HS providers;

Identifies program issues, determines applicable motion and makes suggestions for drawback decision; assists within the implementation of program enhancements and repair enhancements;

Analyzes and interprets present, new and proposed laws for value and program impacts;

Employment Requirements:
Enough schooling and expertise which immediately demonstrates the possession and software of the next information and skills:

Expertise Observe:
The information and skills required to carry out this perform are sometimes attained by means of coaching and expertise equal to a Bachelor’s diploma from a university or college in well being care administration, public administration or a associated area AND 4 years of skilled degree analytical or administrative expertise, two of which have to be in a well being care setting. A Grasp’s diploma in a single of the disciplines listed above could also be substituted for one yr of the non-well being care expertise.

Information of:
Rules and practices of well being care supply methods and the problems shaping the well being care business;

Strategic planning in a well being care setting;

Contracting rules, together with contract analysis and monitoring associated to well being care administration, and well being plan and hospital operation;

Health care and Managed Care laws at Federal, State, and native ranges;

Insurance coverage business practices and healthcare cost mechanisms;

Present Managed Care info techniques points together with enrollment and billing methods, utilization/authorization management and management reporting techniques;

Developments and insurance policies that have an effect on healthcare;

Health care value construction and price evaluation, healthcare and managed care financing/reimbursement rules;

Statistical evaluation and methods together with pc based mostly statistical packages;

Present laws and tendencies in authorities coverage that have an effect on well being care suppliers;

Means to:
Analyze well being care utilization and monetary implications;

Administer and monitor contract efficiency;

Direct and coordinate different division employees in resolving operations points;

Develop enterprise relationships and alliances with group suppliers;

Develop and write insurance policies, procedures and projections;

Formulate, collect, analyze and current monetary, informational and statistical knowledge;

Consider program info and attain legitimate conclusions;

Talk clearly and successfully with the general public, company employees and well being care professionals in any respect degree;

Set up and keep efficient communication with management, different well being businesses/suppliers, and most of the people;

Symbolize SCVHHS on assigned committees and with service suppliers.

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