Provider Contracting Manager

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee provider contracting and network development across all lines of business.

• Design, implement, and sustain a strategic approach to provider networks.

• Regularly assess the network to guarantee cost-efficiency and optimal performance.

• Collaborate with Sales & Marketing and Health Services to create initiatives that align with market growth and medical cost objectives.

• Negotiate contracts with hospitals, Federally Qualified Health Centers (FQHCs), physicians, and ancillary service providers for all product offerings.

• Facilitate provider orientations and deliver ongoing education for network participants.

• Clarify fee-for-service and risk-based contracts.

• Manage physician networks by fostering and sustaining relationships within designated geographic areas.

• Address providers’ contract inquiries and requests.

• Assess network deficiencies and identify potential providers for contracting.

• Review and update provider contracts when necessary.

• Evaluate the performance of contracted networks to ensure operational effectiveness.

• Research and cultivate relationships with non-contracted providers.

• Gather credentialing and necessary documentation for newly contracted providers.

• Undertake special projects as assigned.

⛳️ Requirements

• Preferably possesses Medicare experience.

• 3 to 5 years of experience in a Managed Care setting, Network Management, or Provider Services.

• Experience in hospital contracting or a related Network Management role with the capability to execute the responsibilities of the position.

• Proven negotiation, analytical, and problem-solving abilities.

• Familiarity with provider reimbursement methods and claims processing systems.

• Strong verbal and written communication skills, including interpersonal and presentation abilities.

• Capability to work effectively and independently.

• Proven track record of effectively managing multiple priorities.

🏝️ Benefits

• Comprehensive health coverage options.

• Competitive salary and performance-based incentives.

• Opportunities for professional development and career advancement.

• Flexible work arrangements to support work-life balance.