Director, Market Provider Contracting

🔥 45 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $135.6k - $237.4k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Execute contracting strategy and develop provisions based on cost, quality, and analysis • Conduct annual effectiveness reviews of contracting strategies and ensure corporate compliance • Lead provider recruitment and contract implementation • Manage contract testing, system setup, post-configuration testing, maintenance, and claims-system audits • Create contract language and work with legal to develop approved contract templates • Administer provider contracts, terms, and reimbursement rates in compliance with corporate policies • Implement efficient provider onboarding processes • Ensure network adequacy, member access, cost effectiveness, competitiveness, stability, and regulatory compliance • Perform gap analyses, identify and implement risk-mitigation solutions, and develop corrective action plans • Manage access grievance intake, analysis, and performance improvement initiatives • Participate in provider and staff training sessions • Support contracting requirements across geographic regions and products • Implement initiatives to improve Provider Satisfaction Scores annually • Assist with payment policy and provider notification development and review • Collaborate on member reassignment processes related to provider terminations as required by the state • Maintain staff engagement, empowerment, and development • Perform other job-related instructions as requested

🎯 Requirements

• Bachelor’s degree in a healthcare related field, or equivalent work experience is required • Master’s Degree or equivalent work experience is preferred • Minimum three (3) years of contract negotiation experience is required • Minimum three (3) years of management experience is required • Managed care experience is highly preferred • Intermediate proficiency with Microsoft Outlook, Word, and Excel • Knowledge of Network Management Processes & Services • Ability to manage and prioritize multiple tasks • Effective oral and written communication skills • Critical listening and thinking skills • Training/teaching skills • Time management skills • Annual influenza vaccination is required for designated positions during influenza season, with proof of vaccination required for continued employment • Ability to travel up to 30%

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Annual influenza vaccination requirement and related immunization support • Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs