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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.
Function/Duties of Position
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; Compensation consistent with Fair 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 to contracting 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)
Internal Number: 2020-5105
Oregon Health & Science University is a nationally prominent research university and Oregon's only public academic health center. U.S. News and World Report has named OHSU Hospital the No.1 Hospital in Oregon. We educate health professionals and scientists and provide leading-edge patient care, community service and biomedical research. OHSU employees are Torchbearers. It’s not only a job, it's a calling.