Strategic ACO Contract Manager

🕒 Outubro 23

🌵 Arizona, Florida, +15 estados a mais – Remoto

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $100.300 - $150.465 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

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• Aberta há 19 dias.
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Medica

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1975

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Medica é uma organização sem fins lucrativos de planos de saúde e seguradora com mais de 50 anos de experiência, que oferece planos individuais e familiares, Medicare, Medicaid e planos de saúde fornecidos por empregadores. Ela oferece serviços aos membros e ferramentas para encontrar prestadores de serviços, gerenciar benefícios e reivindicações, programas de bem-estar e iniciativas focadas na comunidade através da Medica Foundation para promover a equidade em saúde.

Descrição

• Develop and maintain provider networks that achieve competitive geographic coverage, stability, unit-cost performance, and trend-management objectives • Produce affordable and predictable networks for customers and business partners • Evaluate and negotiate provider contracts in compliance with company templates, reimbursement standards, and process controls • Establish and maintain relationships with hospital, physician, pharmacy, and ancillary providers • Ensure appropriate distribution of provider specialties within networks • Negotiate and draft provider contract terms aligned with financial goals and standard agreements • Manage contract renewals, amendments, critical dates, and the complete contract lifecycle • Maintain contractual language and fee schedules in line with medical policy changes and reimbursement structures • Manage provider relations, resolve issues, and lead dispute-resolution processes • Assess assigned network and provider performance and identify improvement opportunities • Support network adequacy, provider recruitment, and provider marketing activities • Perform other duties as assigned

🎯 Requisitos

• Bachelor's degree or equivalent experience in related field • 8 years of related work experience beyond degree • Experience negotiating contracts using Value-Based and ACO arrangements • Experience building relationships and establishing trust at all levels • Health plan operations and/or provider operations experience • Excellent written, verbal, and presentation skills • Proven record cultivating and maintaining effective, collaborative external relationships • Successful contract negotiation experience for health care services, providers, or health plans • Flexibility and creativity in developing effective contracting terms • Knowledge of provider contracting components and strategies, including risk-based contracting, financial models, operational impact, and data analytics • Understanding of complex financial arrangements and quality programs across health care products • Strong financial, analytical, and problem-solving skills • Understanding of legal documents • Strategic-thinking skills and ability to analyze complex scenarios • Primary home address within a state where Medica is registered as an employer: AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, or WI • Legally authorized to work in the United States; Medica does not offer work visa sponsorship

🏖️ Benefícios

• Competitive medical, dental, and vision benefits • Paid time off (PTO) • Holidays • Paid volunteer time off • 401(k) contributions • Caregiver services • Incentive plan compensation may be available in addition to base salary

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