Provider Contract Manager II

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Create and sustain provider networks that are competitive, geographically stable, and aligned with unit cost and trend-management goals.

• Assess network adequacy, market trends, provider availability, and specialties.

• Review and negotiate provider contracts, reimbursement models, and proposed terms.

• Engage in routine negotiations with physicians, ancillary providers, and smaller facilities.

• Ensure contracts adhere to templates, reimbursement standards, legal requirements, and documentation guidelines.

• Evaluate the financial implications of proposed contract terms and escalate any exceptions.

• Manage ongoing provider contract inquiries, relationships, and escalations.

• Communicate performance metrics, contract requirements, and network initiatives effectively.

• Assist providers in understanding reimbursement methodologies, operational workflows, and administrative processes.

• Participate in provider meetings and workgroups.

• Analyze claims, costs, and utilization data to identify trends influencing contracting decisions.

• Utilize market intelligence, benchmarking, and models to formulate negotiation strategies, summaries, and recommendations.

• Monitor competitor activities and regulatory changes impacting network structure.

• Suggest enhancements to contracting workflows, tools, and documentation.

• Collaborate with legal, finance, provider operations, and clinical teams to execute contracts.

• Engage in value-based contracting, quality programs, and cost-of-care initiatives.

• Share insights and best practices with colleagues.

⛳️ Requirements

• Bachelor’s degree or equivalent experience in a related field.

• Over 3 years of professional experience in contract negotiations and knowledge of the healthcare WI market within provider contracting.

• Basic experience in health plan operations and/or provider operations.

• Exceptional written, verbal, and presentation skills.

• Capability to work independently, exercise sound judgment, and recognize when escalation is necessary.

• Proven success in building and maintaining effective, collaborative external relationships.

• Demonstrated success as a contract negotiator for healthcare services, providers, or health plans.

• Flexibility and creativity in crafting effective contracting terms.

• Understanding of provider contracting components and strategies, including risk-based contracting, financial models, operational impact, and data analytics.

• Demonstrated comprehension of complex financial arrangements and quality programs across healthcare products.

• Strong financial, analytical, and problem-solving capabilities.

• Familiarity with legal documents.

• Strategic thinking skills with the ability to analyze scenarios and determine viable options.

• Primary residence must be 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 provide work visa sponsorship for this position.

🏝️ Benefits

• Competitive medical, dental, and vision insurance.

• Paid time off (PTO).

• Holiday pay.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.

• Incentive plan compensation may be available in addition to the base salary.

• Numerous other benefits to support employees.