PR Contract Management

Role Purpose:

To accomplish effective contract management and network design of the providers through the implementation of the agreed providers’ strategy and framework while complying with CCHI & SAMA rules& regulations to deliver effective price & cost management and projects’ savings .In addition ,aligning with sales & marketing to continuously developing new products & services that support business development &proposition in the insurance market and achieve business profitability and expansion goals.

Key Accountabilities:

1- Contract Management;

• Set up the contracts’ rules and standards with all providers for the best interest of the business
• Supervise contracting (and engage whenever necessary) new providers ,new service codes and the renewal of contracts.
• Ensuring contracts’ compliance with the regulatory, renewals and licensing requirements.
• New Providers facility field visit, evaluation & scoring.

2- Benchmarking;

• Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network)
• Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by members or other business units.
• Develop pricing models, guidelines & benchmarks for optical and other unique services.

3- Pricing, Discounts and Coding;

• Revamp the coding system and ensure cleaning up redundancy and duplication.
• Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.
• Develop standard discount structure, PPD rules and slabs of volume discount

4- Cost Effectiveness;

• Develop (and negotiate whenever necessary) price reduction plans to achieve business goals.
• Develop and enhance plans to agree with the providers on services’ bundling (in & outpatients) and expansion of surgical packages.
• Ensure (and negotiate whenever necessary) that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets.
• Provide business stakeholders with price forecasting on regular basis and whenever necessary.

5- Network Design and Management;

• Ensure that the network of providers is comprehensive and covering all benefits for each class.
• Enhance, regularly, the providers network (down/up grading) based on risk cost and business requirements
• Optimize accessible and affordable network.
• Practice type network management.

6- Volume Allocation;

• Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
• Develop network of anchor providers and centres of excellence
• Manage volume re-allocation of all or specific services from one provider to another whenever indicated

7- Service Innovation;

• Explore and develop new payment approaches to cope with business growth like paradigm shift, prepaid services, and accountable care organization.
• Explore and develop partnership relations with strategic providers
• Introduce healthcare plans that respond to market needs, health & benefits and business developments.
• Develop new products and services, e.g. Fast track, external doctors, special arrangement (SPA), High skills physicians’ network, maternity and uncovered services.

8- Coordination and Communications;

• Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stakeholders.
• Communicate regular price forecast to the commercial finance
• Communicate network redesign, referral system updates to operation team and sales.
• Coordinate with sales, marketing and commercial finance volume re allocation ,healthcare plans and network updates.

9- People Management;

• Provide leadership, professional guidance and directions to the assigned team members.
• Preparing and overseeing KPI for the team.
• Ensure and facilitate goal setting; manage and constantly review individual performance
• Provide regular feedback, coaching, and development
• Motivate, empower and enable direct reports by providing technical expertise, necessary tools and support required to achieve the organizational development objectives
• Build the capabilities of the team members.

• Familiarity with healthcare pricing and emerging models of care in the market.
• Analytical mindset & Presentation skills.
• Hospital management (preferrable)
• Contracts & Prices negotiations.
• Good knowledge of health insurance market regulations.
• 2 years in medical practice would be an advantage.
• Health Economics/Healthcare & Business Administration related studies would be an advantage.

Medicine and Surgery