Associate Director of Provider Network and Contracting

South Country Health Alliance • Medford, MN

2d • $117,000 - $139,713 • Hybrid

About The Position

Associate Director of Provider Network and Contracting South Country Health Alliance South Country Health Alliance is seeking an Associate Director of Provider Network and Contracting to join our team! In this role, you will provide operational direction and leadership to South Countrys Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, and ensure South Countrys adherence with network management goals, state, federal and other regulatory requirements. Why South Country? South Country Health Alliance is more than a health planwere a mission-driven organization dedicated to improving health and well-being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in peoples lives. [mnscha.org] Join us and be part of an organization that values community impact, employee well-being, and innovation. Must be legally authorized to work in the U.S. (No sponsorship available) This position is responsible for providing operational direction and leadership to South Countrys Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, and ensure South Countrys adherence with network management goals, state, federal and other regulatory requirements. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able and willing to travel regionally is support of job responsibilities. The mental and physical requirements described here are representative of those that must be met by an individual to successfully perform the essential functions of this position.

Requirements

• Bachelors degree in a health care or business-related field or other relevant field
• (5) Five years experience in health care delivery setting (e.g., hospital, health insurance, HMO or community service provider, physician group practice)
• (3) Three years experience in contract and pricing management in health care
• Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products
• Direct contracting and negotiation experience with providers.
• Outstanding oral, written, and interpersonal communication skills
• Demonstrated leadership ability
• Exceptional conflict and problem resolution skills
• Strong organization skills
• Proficient in providing high-level customer service
• Strong financial analysis skills and ability to analyze data and processes and apply them to network development and contracting
• Self-starter and ability to take initiative
• Excellent presentation skills
• Well-developed project management and negotiation skills.
• Strong listening, verbal, presentation and written communication skills
• Advanced language skills including inquiry skills to assure clear issue identification
• Ability to articulate complex issues effectively to a variety of audiences
• Writing is clear and to the point
• Chooses the appropriate method of communication to meet customer and organizational needs. Must be able to read and write in English.
• Advanced mathematical skills.
• Intermediate to advanced data analysis and financial modeling skills.
• Ability to calculate and forecast pricing methodologies.
• High attention to detail and considerable accuracy is required of this position
• Must utilize keen judgment and highly developed analytical skills in balancing complex business issues in the decision-making and strategy-setting process.

Nice To Haves

• Knowledge of and experience with provider credentialing and related processes

Responsibilities

• Coach, mentor, and manage a team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support South Countrys strategic provider-related goals.
• Lead, develop and implement South Countrys provider network contracting activities, and responding to access and availability enhancement goals. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions.
• Along with the Compliance Officer and the CFO, negotiate contractual relationships with providers that support SCHAs strategic, financial, operational, and program-specific goals, utilizing an appropriate reimbursement methodology consistent with network strategy and contracting goals. Ability to work with outside consulting actuaries on structure and financial modeling of programs.
• Develop an annual contract renewal and negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to South Country leadership and key committees.
• Maintain a working knowledge of State of MN and CMS provider reimbursement methodologies and other relevant strategies and ensure this information is presented to South Country operational areas as may be relevant to support South Countrys policies and strategies.
• Develop and maintain network oversight plans by provider/network type. Ensure contractual, regulatory and NCQA compliance for network providers.
• Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services.
• Work effectively with South Countrys Compliance Officer, CFO, leadership, program managers, operations staff and selected third party administrators to ensure that the South Country provider contracts are understood and interpreted (for system implementation) for accurate administration.
• Other duties assigned within the scope, responsibility and requirements of the job.

Benefits

• Medical, dental, vision, life insurance, short- and long-term disability, pension (PERA)
• Hybrid and remote options with quarterly on-site expectations.
• Structured step-based salary system for transparency and stability.

What This Job Offers

• Job Type: Full-time
• Career Level: Director