Korn Ferry · 19 hours ago
Managed Care and Pharmacy Contracts Program Manager
Sacramento, CA
Full-time
Onsite
Senior Level
$150K/yr - $170K/yr
5+ years expKorn Ferry has partnered with their client to find a Managed Care and Pharmacy Contracts Program Manager. This role involves drafting, negotiating, and overseeing managed care and pharmacy contracts, ensuring compliance with federal and state laws, and providing support to internal staff regarding contractual terms.
Management Consulting
Responsibilities
Negotiate and manage payor, pharmacy and health plan contracts responsible for system revenue in excess of $2 billion
Evaluates, reviews, analyzes and/or develops Managed Care Contracts agreements for UCDH managed care programs and arrangements
Negotiates HMO/PPO health plan/payor, insurance company, third party administrator, payor/specialty network, external provider, pharmacy and downstream agreements; drafts contracts (or modifies payor agreements) and related documents incorporating negotiated terms, implements and administers the contract during its in-force life
Develops, reviews, documents and presents financial and operational analysis/assessments/due diligence as part of contract negotiation and implementation
Interacts with internal constituents in the development of contract terms
Evaluates contractual and other transactions to identify potential conflicts with University objectives, policies or procedures; adverse impacts on campus programs or resources; and obligations or liabilities (financial or legal) incompatible with University interests
Drafts documents (or reviews/modifies those of others if contracting party requires) to comply with federal & state law, regulations, strategic direction of the health system and University policy
Develops/provides supporting documentation for final approval and execution of assigned portfolio contracts
Identifies needs for adoption/revision of policies and/or procedures and reviews proposed policy and/or procedure statements prepared by others, as requested; develops proposals for action, presents recommendations to appropriate administrative and management staff
Contributes to the documentation and interpretation of various managed care contractual reimbursement and operational terms for internal and external constituents
Assures all assigned managed care contracts plus other supporting documents are complete and accurate in content; clear and logical in organization; consistent with applicable standards of form; and effective in assuring coordination of related actions
Identifies nature of proposed contracts to determine appropriate processing procedures
Locates/obtains information needed for performance of duties
Researches specific problems or topics as assigned
Evaluates requests for approval of exceptions to policy
Serves as liaison among faculty/staff, campus administrators and government/private entities; works closely to develop supporting operational processes
Coordinates with health system legal, governmental, technical and policy guidelines in development of processes. Provides direction/guidance/advice to UCDH faculty/staff and to public and private entities to resolve sensitive, complex and unique contract/managed care problems
Works closely with contracting second parties, faculty/staff, University regulatory and financial departments and public authorities regarding post- execution contract administration
Resolves minor disputes, provides assistance for the implementation of all managed care contracts. Documents all changes in the contract through written amendment
Responds to inquiries and participates in various work groups and committees
Apprises department/division management and affected external UCDH business units of policy/procedure/program changes in area of primary responsibility/assigned portfolio
Develops/implements appropriate communication with UCDH and contracting parties to transmit changes and assist in implementation
Develops agendas and content for workgroups and meetings
Issues updates to managed care contracting changes
Represents UCDH Contracts Office at workshops and seminars; participates in and presents at campus-wide, regional and professional meetings
Qualification
Required
Bachelor's degree in business or related field and/or equivalent combination of education, training, and experience
Advanced business or related degree, or degree in Law
Demonstrated advanced experience and knowledge pertaining to managed health care programs, products, operations and policies
Demonstrated extensive experience preparing and negotiating complex managed care payor and provider contracts documented
Experience negotiating hospital, medical group, ancillary, pharmacy and/or downstream agreements in a health care provider and/or a payor setting
Advanced ability to communicate in writing in a clear, concise and professional manner, via email, letter, and contract documents with the ability to interact with a wide variety of individuals and groups in the healthcare private and public sectors, government, non-profit organizations, and educational institutions, as well as with UCDH faculty and staff
Advanced ability to exercise personal initiative and direction, to maintain a sense of self-confidence sufficient to enable responsibility for decisions, attempt difficult or unfamiliar tasks, develop new sources of information, present recommendations persuasively, and to provide/receive advice effectively
Advanced ability to make sound decisions and recommend appropriate strategies/resolutions to department management based upon knowledge and data
Operating knowledge and skills necessary to utilize current business and healthcare system applications such as MS365, Word, Excel, SharePoint, Teams, Adobe, meeting Apps, EPIC, etc
Advanced detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts and effectively carry out all contracting activities
Advanced critical-thinking, problem-solving, and project-management skills to effectively manage and prioritize multiple levels of information and responsibilities, manage projects from inception to completion, assess complex problems and develop an expedient path of resolution
Preferred
5+ yrs payer or provider contracting negotiation experience with a healthcare payer/plan and/or a provider/academic provider is preferred
Familiarity with UCDH's C360 Contract Management Software is preferred
Financial modeling skills with expertise in medical data, spreadsheets and database applications is preferred
Demonstrated knowledge of pertinent university policies and procedures falling within the scope of the position is preferred
Company
Korn Ferry
Korn Ferry is a global consulting firm that powers performance.
10001+ employees
H1B Sponsorship
Korn Ferry has a track record of offering H1B sponsorships. Please note that this does not
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2025 (11)
2024 (11)
2023 (5)
2022 (16)
2021 (12)
2020 (25)
Funding
Current Stage
Late StageLeadership Team
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Senior Consultant - CEO Impact Accelerator
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Principal - Executive Search / CEO & Board Services
Recent News
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