About this role
Salary Range: $126,821.00 (Min.) - $168,037.00 (Mid.) - $209,255.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary 6 open positions: The Senior Advisor Contract Management and Execution manages provider contracting activities from initial opportunity through final execution, including reimbursement evaluation, negotiation strategy, contract language, approvals, and renewals. This position develops and maintains contracting work plans and documentation, leads provider negotiations within established parameters, and serves as the primary contracting representative for assigned providers. The Senior Advisor identifies and addresses renewal and amendment needs, escalates risks as necessary, and consistently communicates the health plan’s contracting positions, ensuring strong provider relationships and organizational integrity. This position collaborates with key stakeholders to review programs, projects, processes, procedures, and policies; and to conduct end-to-end root cause analysis to enhance and improve outcomes and remediate issues to comply with the national and statewide standards and regulations. Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics. Duties Serves as the expert and steward of provider contracting activities, guiding each engagement from initial opportunity to final execution. Manage reimbursement and financial evaluations, negotiation strategy formulation, contract language negotiation, internal review and approval processes, and the full spectrum of contract execution, amendment, and renewal activities. Develops, maintains, and manages robust contracting work plans and timelines, ensuring seamless stakeholder approvals and meticulous documentation of all contracting activity. Leads provider negotiations consistently aligning proposed terms with established financial, contractual, legal, and strategic parameters. Navigates, modifies, and negotiates provider agreements, exhibits, reimbursement schedules, amendments, counterproposals, concessions, and closing strategies in accordance with established organizational guidelines and approval parameters. Escalates matters when proposed terms exceed established parameters or present material risk. Identifies upcoming contract renewal dates, notice requirements, expiring rate terms, and amendment needs, and initiates provider negotiations to minimize contract expiration or continuity risk. Serves as an expert on contracts by communicating contracting positions, requirements, and negotiation parameters to provider organizations. Develops reports, analyzes data and provides presentation on status of areas of responsibilities on an as needed basis in support of department operations. Partners with the management to communicate compliance and operational priorities and provide feedback or follow-ups to key stakeholders. Acts as the point of contact for key strategic initiatives. Provides expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance. Conducts research and analysis of business performance and improvements with key stakeholders to document current state, identify gaps and present remediation plan/options to leadership. Leads the implementation of initiatives and monitor for successful outcomes. Performs other duties as assigned. Duties Continued Education Required Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: At least 6 years of experience managing the full provider contracting lifecycle, including financial evaluation, negotiation, contract language, approvals, and renewals. Preferred: Experience in data analysis, understanding payment rates, and managing healthcare costs. Skills Required: Strong project leadership skills, with the ability to develop and execute contracting work plans, manage timelines, coordinate stakeholder approvals, maintain documentation, and lead negotiations. Strong risk management skills, with the ability to proactively identify contract renewal, amendment, and continuity risks. Negotiation skills, with the ability to align contract terms with organizational parameters and effectively navigate complex agreements, amendments, counterproposals, and closing strategies. Strong communication and relationship management skills, with the ability to establish credibility, communicate effectively with external providers, uphold organizational integrity, and foster productive stakeholder relationships. Ability to clearly and effectively convey information. Strong presentation skills. Ability to analyze complex situations, data, and information to identify issues and develop effective solutions. Ability to adjust to changing trends, industries, and client needs. Possess extensive, specialized knowledge in their field. Preferred: Advanced knowledge of managed care contracting, provider reimbursement, contract language, and health plan operations. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Required: Travel to offsite locations for work required. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)