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Top Provider Network Contracting Executive

Provides executive leadership and coordination over Provider Network Contracting operations to include development and implementation of strategic plans that provide sound provider interaction and contracting.: Responsible for the research, policy development, contract development and expansion of the provider network. Plans, organizes and directs the Provider Network Contracting department. Organizes, controls, and evaluates the implementation of strategic plans that provide strong provider relations and contracting. Formulates and administers departmental policies. Plans, organizes, implements and evaluates outcomes of the department’s strategic plans. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to provider network contracting. Develops new strategies to enhance service and improve overall performance. Develops and maintains administrative and regulatory compliance systems. Reviews budgetary recommendations, and manages and monitors the departmental budget. Hires, develops and motivates a qualified staff. An advanced degree is typically required for this position with seven years of provider relations and contracting experience in managed care.

Medical Top Level Nursing Executive

Directs, through managers, supervisors or head nurses, activities of nursing staff. Administers nursing program in hospital or other medical institution to maintaining standards of patient care. This is the highest level position in patient care.: Plans and organizes activities in nursing services, such as obstetrics, pediatrics, or surgery, or for two or more patient-care units to ensure patient needs are met in accordance with instructions of physician and hospital administrative procedures. Coordinates activities with other patient care units. Advises medical staff, department heads, and hospital administrator in matters related to nursing services. Recommends establishment or revision of policies, and develops organizational structure and standards of performance. Interprets policies and objectives of hospital nursing services to staff and community groups. Performs personnel management functions. Plans and organizes orientation and in-service training for unit staff members, and participates in guidance and educational programs. Assists in formulating budget. Engages in studies and investigations related to improving nursing care. May direct activities of school of nursing.

Managed Care Contracting Manager

Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.: Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. Responsible for the oversight of all contract coordination activities. Represents the organization to the employer community and solicits business. Works with current subscribers to develop additional business opportunities. Coordinates contract negotiation and resolves complex issues. Works closely with physicians in program development and specialist relations. Monitors managed care contract performance and addresses related concerns. Evaluates potential business opportunities and develops innovative approaches that can benefit the organization. Attempts to standardize contracts to ensure effective and efficient implementation. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.

Head of Medical Contracting

Negotiates to draw up contracts for managed care services related to physician groups. Negotiates, administers, extends, terminates, and renegotiates contracts. Formulates and coordinates proposals. Coordinates activities of workers engaged in formulating bid proposals. May report to Top Managed Care Executive, Chief Executive Officer, or Chief Financial Officer in organization.: Evaluates or monitors health outcome and contract performance to determine necessity for amendments or extensions of contracts, and compliance to contractual obligations. Approves or rejects requests for deviations from contract specifications. Arbitrates claims or complaints occurring in performance of contracts. May serve as liaison officer to ensure fulfillment of obligations by contractors.

Medical Contracting Head

Medical Head of Contracting

Level Glass Forming Machine Operator

Tends battery of automatic machines that flame-cut and form vials for level from glass tubing: inserts tubing in holder to feed machine. Replenishes tubing and replaces fill catch boxes. Examines formed glasses for defects, such as unclosed bottoms, elongated tops or misshapen vials, and notifies machine adjuster of machine malfunctioning. Removes formed glasses to workbench and files points from glasses to leave opening for filling, using half-round file.

Level Glass Vial Filler

Tends equipment that fills glass vials with alcohol or ether solution and leaves air bubble to form vials used in tools and instruments to determine levelness: fills rack with vial-filled cups and lowers rack into tank of solution. Lowers weighted glass cover and moves lever to turn on air pressure. Sets timer for designated time cycle. Shuts off air and raises cover when bell rings. Compares bubbles in random sampling of filled vials with master vial for conformance to size. Refills vials or lets vials stand to evaporate excess fluid to regulate size of bubble. Pours solution from jug into tank to replace used fluid.

Contract Compliance Representative (Entry)

Determines provider compliance throughout a region and recommends appropriate actions.: This position is typically responsible for learning investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Conducts ad hoc investigations. This position typically requires at least one year of underwriting experience.

Contract Specialist

Negotiates with suppliers to draw up procurement contracts. Negotiates, administers, extends, terminates, and renegotiates contracts. Formulates and coordinates procurement proposals. Coordinates activities of workers engaged in formulating bid proposals. Typically reports to supervisory level in organization.: Evaluates or monitors contract performance to determine necessity for amendments or extensions of contracts, and compliance to contractual obligations. Approves or rejects requests for deviations from contract specifications and delivery schedules. Arbitrates claims or complaints occurring in performance of contracts. Analyzes price proposals, financial reports, and other data to determine reasonableness of prices. May negotiate collective bargaining agreements. May serve as liaison officer to ensure fulfillment of obligations by contractors.

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