The Physician Services Contract Manager (PSCM) works in conjunction with the OHSU Office of Community Engagement & Support (OCES) and is responsible for leading and managing the contractual relationships with all outside organizations for OHSU practitioners where, (1) OSHU partners through placement of OHSU clinicians at partner sites/clinics or (2) OHSU practitioners who provide medical services, consultation and/or medical directorships to governmental and community-based programs/clinics. The PSCM works with department administrators to negotiate the terms of such agreements that ensure contracts meet compliance with OSHU Policy and Procedures and ensures that all OHSU contract language imperatives are included in all contracts. Such policies include market-based reimbursement terms, adequate insurance and OHSU Risk Management approvals and standards. This position works directly with OHSU Sr. Leadership, OHSU Legal Counsel, Outside Counsel, OHSU Risk Management, OHSU Accounting & Finance as well as all medicine departments within OHSU.
Key Responsibilities & Performance Standards:
A focus on understanding the strategies of the OHSU health system overall (inclusive of payor strategy, IDS strategy, community outreach) and how these strategies can best be supported through the Off-Campus work faculty and other providers provide.
Building the capabilities of this new office, including improved reporting capabilities and tools for departmental use to ensure that all current and new contracting opportunities meet the financial, mission, and strategy goals of the OHSU health system. Ongoing review and updating of policies and procedures required annually.
Monitor and advise OHSU Leadership on areas of concern that develop or have the potential to develop challenges within the relationships with outside entities. Provide options to improve relationships with outside entities.
Working collaboratively with all department clinical and operational leadership at OHSU, as well as OHSU Legal, Risk Management, Medical Affairs to improve the efficiency of the current Off-Campus contracting process, and to ensure open lines of communication.
Establish quarterly operational outreach meetings with key sites where OHSU holds multiple contracts to discuss any current issues or additional opportunities for collaboration.
Negotiation, documentation and standardization of all existing contracts to ensure: language compliant with all Federal and State Laws, OHSU Legal, and OHSU Risk Management; Compensationconsistent withFair Market Value; and current contracts in line with OHSU Health strategy.
Maintain an up-to-date understanding of key elements of contracts including contract language requirements, policy impacts, and rate structure to ensure OHSU meets all local and federal requirements through contract provisions.
3 years experience in a healthcare industry provider/payer contracting, provider/payer relations, or analytical capacity or equivalent combination of education and experience.
Knowledge and experience in legal assistance, risk management and physician reimbursement.
General understanding of insurance and indemnification terms.
Proven ability to build positive relationships and negotiate successfully with both OHSU partners and outside organizations.
Ability to analyze financial, operational and legal implications of various contract models.
Ability to organize and lead a portfolio of contracts with moderate supervision.
Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity.
Understanding of clinical and/or hospital operations including patient billing and reimbursement methods.
Knowledge of provider and payer community.
Strong oral and written communication skills.
Must be able to perform the essential functions of the position with or without accommodation.
4+ years experience in the healthcare industry in physician recruiting or leadership role in clinic/billing operations, provider/payer contracting, provider/payer relations, or equivalent.
Strong understanding of managed care and accountable health system models and relationship tocontracting strategy and reimbursement methodology.
Demonstrated competency related to varying payment methodologies and value base contracting. (such as Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem,Per Case)
Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or email@example.com.
As the state's only health and research university, OHSU brings together patient care, research, education of the next generation of health care providers and scientists and community service to improve the health and well-being of all Oregonians.The university is a conduit for learning for more than 2,800 students, providing training to interns, residents and fellows in postgraduate medical and research. It is the only place in Oregon that grants doctoral degrees in medicine, dentistry and nursing. OHSU cares for more than 251,000 patients each year from around the region and takes a leadership role in contributing to solutions involving the health of the state and the nation, such as health care access and transparency, ethics and workforce shortage. Beyond providing critical health care services, quality education and cutting-edge research, OHSU also is a key economic and social force in the Northwest. With an annual operating budget of $2.06 billion and more than 14,000 employees, OHSU is Portland?s largest employer. Its size contributes to its ability to provide... many services and community support activities not found anywhere else in Oregon. For more information visit http://www.ohsu.edu/xd/about/index.cfm