Senior Manager, Provider Network Management

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

📋 Description

• Negotiates, executes, reviews, and analyzes contracts and manages dispute resolution and settlement negotiations.

• Oversees contract performance to ensure compliance and efficiency.

• Contributes to the development of provider compensation and pricing, including the submission of contractual information and the review and analysis of reports during negotiation and reimbursement modeling activities.

• May enhance interactions with assigned providers and internal business partners to foster relationships and meet provider needs.

• Ensures the resolution of escalated issues related to claims payment, contract interpretation and parameters, or the accuracy of provider contracts or demographic information.

• Recruits providers as necessary to achieve network expansion and adequacy goals.

• Responsible for identifying and recommending strategies to manage cost issues while supporting cost-saving initiatives and/or settlement activities.

• Assists in the design, development, management, and implementation of strategic network configurations.

⛳️ Requirements

• Must reside in Indiana.

• 5-7 years of relevant experience, demonstrating a comprehensive level of negotiation with individual or complex provider systems or groups, or completion of a General Management Development Program (GMDP) along with other relevant experience.

• Familiarity with Indiana provider systems and the market landscape.

• Ability to communicate with internal and external parties via phone or in person; minimal travel to offsite provider groups and/or health system locations is expected.

• Related experience in health operations, network relations and development, as well as a strong grasp of financials and pricing strategies, along with sales interface experience.

• Proven experience in building and maintaining relationships with provider systems.

• A successful history of managing and negotiating significant provider contracts.

• In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.