Director Provider Contracting - JHP

Jefferson Health Plans • Philadelphia, PA

3d

About The Position

The Director of Provider Contracting is responsible for leading the contracting initiatives and strategies across JHP's provider network. The Director Provider Contracting leads all end-to-end provider contract discussions for JHP's state-wide provider network.

Requirements

• Bachelor’s Degree
• 5 years experience in managed care and provider contracting
• 3 years in a management (or equivalent level) position.
• Knowledge of managed care administration and standards, regulations and laws applicable to contracting.
• Strong negotiation and conflict resolution skills required.
• Knowledge and understanding of claims processing, member services, and provider services as they relate to provider contracting.
• Excellent organizational, interpersonal, time management and communications skills.
• Process and project management ability.
• Strong Microsoft Office skills
• Auto insurance required.
• DL - Driver's License_PA - State of Pennsylvania

Nice To Haves

• Preferred contracting experience.
• Experience in managing cross-functional projects and teams in claims, customer service, and/or provider affairs areas preferred.

Responsibilities

• Oversees and leads negotiations of provider contracts for JHP’s provider network.
• Manages day-to-day contractual relationship with the JHP provider network.
• Works with internal customers (e.g., provider reimbursement, configuration, and network account managers) to assist in resolving any issues arising from the provider network.
• Evaluates provider network gaps and proposes modifications to network.
• Recruits providers for provider network gaps in conjunction with the network development team.
• Maintains and fosters a collaborative relationship with internal and external customers.
• Manages contract portfolio budget and controls expenses while meeting operational, network, and service requirements.
• Manages the accurate and timely implementation of all provider contracts, paying special attention to meeting all applicable regulatory requirements.
• Perform other duties as assigned.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

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