ACO Provider Contract Manager

Medica•Omaha, NE

1d•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Develop and maintain ACO provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.

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
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates 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.
Produces an affordable and predictable network for customers and business partners.
Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
Negotiate and draft contracts: Negotiate terms with providers, ensuring they align with Medica's financial goals and standard template agreements.
Manage contract renewals and amendments: Track critical dates, manage the renewal process, and handle amendments as needed.
Maintain contracts: Keep contractual language and fee schedules up-to-date with current medical policy changes and reimbursement structures.
Oversee the entire contract lifecycle: Manage all stages, from initiation and negotiation through execution, monitoring, and closure.
Build and maintain relationships: Develop and nurture strong relationships with providers, including high-level representatives of key contracting entities.
Resolve issues: Manage provider relations, address issues, and lead dispute resolution processes.
Conduct performance assessments: Regularly evaluate the performance of assigned networks and providers to identify areas for improvement.
Support network growth: Participate in activities related to network adequacy, provider recruitment, and marketing for providers.