Health Partner Network Manager- Georgia Hybrid

CareSource•Georgia WFH, GA

5d•$72,200 - $115,500•Hybrid

About The Position

The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market. This role is responsible for provider recruitment, contracting, and initiating the loading and credentialing processes. It involves analyzing financial data, establishing rates, and negotiating contracts with hospitals, ancillary providers, physicians, and behavioral health providers. The manager will also build networks for new products, ensure compliance with regulatory requirements, and perform gap analyses to identify and mitigate risks. Additionally, this role may involve training providers and staff, supporting corporate contracting needs, and becoming a Subject Matter Expert on specific provider types. Mentoring junior contractors is also a responsibility.

Requirements

Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
Minimum of three (3) years of Healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
Intermediate proficiency level with Microsoft Outlook Word, and Excel
Knowledge of Provider Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Strong negotiation skills
Effective oral and written communication skills
Critical listening and thinking skills
Training/teaching skills
Time management skills
Must have valid driver’s license, vehicle and verifiable insurance.
Influenza vaccination is a requirement of this position.

Nice To Haves

Master’s Degree is preferred
Managed care experience is highly preferred

Responsibilities

Create, execute and administer value based reimbursement (VBR) strategies as directed
Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives
Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
Responsible for following up / auditing providers as they proceed through the loading process to ensure accuracy
Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails
Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance
Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
Build networks to support new products within the market and on-board new providers
Responsible for complying with all regulatory requirements
Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed
Participate in training sessions for providers and staff as appropriate
Support the contracting requirements of the corporation for geographic regions and products
Knowledgeable of federal and state laws and regulations pertaining to provider contracting
Assist with development and review of payment policies and provider notifications
As requested, become a Subject Matter Expert on specific provider types
Mentor junior contractors, as requested
Perform any other job duties as requested