Provider Contract Manager IV

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🕒 vor 10 Tagen

🌵 Arizona, Florida, +15 weitere Bundesländer – Remote

🌵 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 / Jahr

⏰ Vollzeit

🟠 Senior

🔴 Experte

👔 Manager

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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Medica

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 1975

🏥 Gesundheitswesen

🛡️ Versicherung

⚕️ Krankenversicherung

Healthcare • Insurance • Healthcare Insurance

Medica ist ein gemeinnütziger Gesundheitsplan und Versicherer mit über 50 Jahren Erfahrung, der individuelle und Familienpläne, Medicare, Medicaid und vom Arbeitgeber bereitgestellte Gesundheitspläne anbietet. Es bietet Mitgliederdienstleistungen und Werkzeuge zum Finden von Anbietern, Verwalten von Leistungen und Ansprüchen, Wellness-Programme und communityorientierte Initiativen durch die Medica Foundation zur Förderung von gesundheitlicher Chancengleichheit.

Beschreibung

• Develop and maintain ACO provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. • Produces an affordable and predictable network for customers and business partners. • Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. • Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. • Performs other duties as assigned. • Negotiate and draft contracts: Negotiate terms with providers, ensuring they align with Medica's financial goals and standard template agreements. • Manage contract renewals and amendments: Track critical dates, manage the renewal process, and handle amendments as needed. • Maintain contracts: Keep contractual language and fee schedules up-to-date with current medical policy changes and reimbursement structures. • Oversee the entire contract lifecycle: Manage all stages, from initiation and negotiation through execution, monitoring, and closure. • Build and maintain relationships: Develop and nurture strong relationships with providers, including high-level representatives of key contracting entities. • Resolve issues: Manage provider relations, address issues, and lead dispute resolution processes. • Conduct performance assessments: Regularly evaluate the performance of assigned networks and providers to identify areas for improvement. • Support network growth: Participate in activities related to network adequacy, provider recruitment, and marketing for providers.

🎯 Anforderungen

• Bachelor's degree or equivalent experience in related field • 7 years of related work experience beyond degree • Experience negotiating contracts with various methodologies i.e. Value-Based and ACO arrangements • Experience building relationships and establishing trust at all levels • Health plan operations and/or provider operations experience • Excellent communication (written, verbal and presentation) skills • Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that’s conveyed • A proven track record as a successful contract negotiator for health care services, provider or health plan • Flexibility and creativity in developing effective contracting terms • Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics • Demonstrated understanding of complex financial arrangements and quality programs across health care products • Strong financial, analytical and problem solving skills, and understanding of legal documents • Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option.

🏖️ Vorteile

• competitive medical • dental • vision • PTO • Holidays • paid volunteer time off • 401K contributions • caregiver services