Provider Contract Manager IV

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

📋 Description

• Develop and manage ACO provider networks that create a competitive, stable geographic network, achieving targets for unit cost performance and trend management.

• Create an affordable and predictable network for both customers and business partners.

• Assess and negotiate contracts in accordance with company contract templates, reimbursement structure standards, and other essential process controls.

• Establish and uphold robust business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, ensuring the network composition reflects a suitable distribution of provider specialties.

• Perform additional duties as assigned.

• Negotiate and draft contracts: Work with providers to negotiate terms that align with Medica's financial objectives and standard template agreements.

• Manage contract renewals and amendments: Monitor critical dates, oversee the renewal process, and address amendments as required.

• Maintain contracts: Ensure contractual language and fee schedules are current with medical policy changes and reimbursement frameworks.

• Oversee the complete contract lifecycle: Manage all phases, from initiation and negotiation to execution, monitoring, and closure.

• Build and sustain relationships: Foster and nurture strong relationships with providers, including senior representatives of key contracting entities.

• Resolve issues: Handle provider relations, address concerns, and lead dispute resolution efforts.

• Conduct performance assessments: Regularly review the performance of assigned networks and providers to pinpoint areas for improvement.

• Support network growth: Engage in activities related to network adequacy, provider recruitment, and marketing for providers.

⛳️ Requirements

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

• 7 years of relevant work experience beyond the degree.

• Experience in negotiating contracts utilizing various methodologies, including Value-Based and ACO arrangements.

• Proven ability to build relationships and establish trust at all organizational levels.

• Experience in health plan operations and/or provider operations.

• Exceptional communication skills (written, verbal, and presentation).

• Demonstrated success in cultivating and maintaining effective, collaborative external relationships where parties trust the information shared.

• A history of successful contract negotiation for healthcare services, providers, or health plans.

• Ability to exhibit flexibility and creativity in crafting effective contracting terms.

• Knowledge of provider contracting elements and strategies, including but not limited to risk-based contracting, financial models, operational impact, and data analytics.

• A solid understanding of complex financial arrangements and quality programs across healthcare products.

• Strong financial, analytical, and problem-solving skills, along with an understanding of legal documents.

• Strategic-thinking capabilities, with the ability to conceptualize a variety of scenarios and analyze each to determine the most viable option.

🏝️ Benefits

• Competitive medical plan.

• Dental coverage.

• Vision insurance.

• Paid time off (PTO).

• Holidays.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.