Health Partner Network Manager

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $72.2k - $115.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 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 the Health Partner contracting strategy for the assigned market • Develop contract provisions based on cost, quality/analysis, and monitor key metrics • Create, execute, and administer value-based reimbursement strategies • Conduct annual effectiveness reviews of contracting strategies and ensure corporate compliance • Recruit providers, negotiate contracts, and initiate loading and credentialing processes • Follow up with and audit providers during the loading process • Create contract language and collaborate with legal on approved market-specific templates • Analyze financial data and establish rates with Provider Contracting leadership and Finance • Negotiate and renegotiate hospital, ancillary, physician, and behavioral health contracts, terms, and reimbursement rates • Build networks for new products and onboard new providers • Comply with regulatory requirements and perform gap analyses • Identify providers to recruit, implement risk-mitigation solutions, and develop corrective action plans • Participate in provider and staff training • Support contracting requirements for geographic regions and products • Assist with payment policies and provider notifications • Serve as a subject matter expert on specific provider types when requested • Mentor junior contractors when requested • Perform other duties as requested

🎯 Requirements

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required • Master’s Degree is preferred • Minimum of three (3) years of Healthcare experience, including one (1) year of work experience in managed care provider relations or provider contracting • Managed care experience is highly preferred • Intermediate proficiency with Microsoft Outlook, Word, and Excel • Knowledge of Provider Network Management Processes & Services • Strong negotiation skills • Effective oral and written communication skills • Critical listening and thinking skills • Training/teaching skills • Time management skills • Must have valid driver’s license, vehicle, and verifiable insurance • Successful clearance of a driver’s license record check and verified insurance • Influenza vaccination is a requirement of this position • Ability to travel up to 30%

🏖️ Benefits

• Bonus tied to company and individual performance • Substantial and comprehensive total rewards package • Reasonable accommodations for qualified individuals • Influenza vaccination provided/required as a condition of continued employment