ACO Provider Contract Manager

Medica•Omaha, NE

3h•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across Minnesota, Nebraska, Wisconsin, Missouri, and other regions. The organization focuses on delivering personalized healthcare experiences and collaborating with providers to ensure quality member care. Medica operates as a team that values accountability, data-driven decisions, continuous learning, and collaboration. The mission is to support members and employees in critical moments. This role involves developing and maintaining ACO provider networks to achieve competitive, geographic, and stable networks that meet unit cost performance and trend management objectives, ensuring an affordable and predictable network for customers and business partners. The position evaluates and negotiates contracts in compliance with company standards and maintains strong business relationships with various healthcare providers, ensuring an appropriate distribution of provider specialties.

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

Responsibilities

Negotiate and draft contracts, ensuring alignment with Medica's financial goals and standard template agreements.
Manage contract renewals and amendments, tracking critical dates and handling necessary changes.
Maintain contracts by keeping contractual language and fee schedules updated 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.
Resolve provider relations 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.