Provider Contract Manager IV

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🔥 2 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

💵 $100.3k - $150.5k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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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 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.

🎯 Requirements

• 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.

🏖️ Benefits

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