Provider Contract Manager II

🕒 il y a 20 jours

🌵 Arizona, Florida, +15 états de plus – Distant

🌵 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

💵 $70 200 - $120 400 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Medica

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1975

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

Medica est un organisme de santé à but non lucratif et assureur avec plus de 50 ans d'expérience, offrant des plans individuels et familiaux, ainsi que des plans de santé pour les entreprises, Medicare et Medicaid. Il propose des services aux membres et des outils pour trouver des prestataires, gérer les avantages et les réclamations, des programmes de bien-être ainsi que des initiatives orientées vers la communauté à travers la Fondation Medica pour promouvoir l'équité en santé.

Description

• Develop and maintain provider networks that are competitive, geographically stable, and aligned with unit cost and trend-management objectives • Evaluate network adequacy, market dynamics, provider availability, and provider specialties • Review and negotiate provider contracts, reimbursement structures, and proposed terms • Conduct routine negotiations with physicians, ancillary providers, and smaller facilities • Ensure contracts comply with templates, reimbursement standards, legal requirements, and documentation standards • Analyze financial impacts of proposed contract terms and escalate exceptions • Manage routine provider contract questions, relationships, and escalations • Communicate performance metrics, contract requirements, and network initiatives • Support provider understanding of reimbursement methodologies, operational workflows, and administrative processes • Attend provider meetings and workgroups • Analyze claims, cost, and utilization data to identify patterns affecting contracting decisions • Use market intelligence, benchmarking, and models to develop negotiation strategies, summaries, and recommendations • Track competitor activity and regulatory updates affecting network structure • Recommend improvements to contracting workflows, tools, and documentation • Collaborate with legal, finance, provider operations, and clinical teams to implement contracts • Participate in value-based contracting, quality programs, and cost-of-care initiatives • Share knowledge and best practices with peers

🎯 Exigences

• Bachelor's degree or equivalent experience in related field • 3+ years of work experience beyond degree in contract negotiations and healthcare WI market knowledge within provider contracting • Basic health plan operations and/or provider operations experience • Excellent written, verbal, and presentation skills • Ability to work independently, make sound judgment calls, and determine when escalation is needed • Proven track record cultivating and maintaining effective, collaborative external relationships • Proven track record as a successful contract negotiator 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 • Demonstrated 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 scenarios and determine viable options • Primary home address must be located in 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 • Must be legally authorized to work in the United States at the time of application • Medica does not offer work visa sponsorship for this role

🏖️ Avantages

• Competitive medical, dental, and vision coverage • PTO • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Incentive plan compensation may be available in addition to base salary • Many other benefits to support employees