Provider Contract Manager II

🔥 3 minutes ago

🌵 Arizona, Florida, +15 more states – 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

💵 $70.2k - $120.4k / 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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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 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

🎯 Requirements

• 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

🏖️ Benefits

• 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