ACO Provider Contract Manager IV

Medica•St. Louis, MO

111d•$100,300 - $172,000•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states, dedicated to providing personalized healthcare experiences and partnering with providers. The company culture emphasizes accountability, data-driven decisions, continuous learning, and collaboration. This role is responsible for developing and maintaining ACO provider networks to achieve cost performance and trend management objectives, ensuring an affordable and predictable network for customers and business partners. The position involves evaluating and negotiating contracts in compliance with company standards and processes, and establishing strong relationships with various provider types to ensure appropriate network distribution.

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
Must be legally authorized to work in the United States at the time of application.
Employment is contingent on verification of identity and eligibility to work in the United States.

Responsibilities

Develop and maintain ACO provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management.
Produce an affordable and predictable network for customers and business partners.
Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
Establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensure the network composition includes an appropriate distribution of provider specialties.
Negotiate and draft contracts, ensuring they align with Medica's financial goals and standard template agreements.
Manage contract renewals and amendments, tracking critical dates and managing the renewal process.
Maintain contracts by keeping contractual language and fee schedules up-to-date with current medical policy changes and reimbursement structures.
Oversee the entire contract lifecycle from initiation and negotiation through execution, monitoring, and closure.
Build and maintain strong relationships with providers, including high-level representatives of key contracting entities.
Manage provider relations, address issues, and lead dispute resolution processes.
Regularly evaluate the performance of assigned networks and providers to identify areas for improvement.
Participate in activities related to network adequacy, provider recruitment, and marketing for providers.