Health Plan Contract Manager

Community Bridges, INC•Mesa, AZ

22h•Onsite

About The Position

The Health Plan Contract Manager is a key contributor primarily responsible for contracting healthcare services provided by Community Bridges, Inc. (CBI) with Medicaid, Medicare, Commercial payers, and government entities. This role serves as the internal point of contact for health plan contract needs, implements contracting strategies identified by the Executive Leadership Team (ELT), and collaborates with all internal departments to ensure awareness and knowledge of contract requirements. The manager participates in payer Joint Operations Committee (JOC) meetings and is involved in contracts with Accountable Care Organizations. They work closely with the VP Payer Relations to provide status updates on contracting opportunities, existing contracts requiring amendments, and ensure legal review before recommending signature. Additionally, this position is responsible for establishing structures to track and monitor contracts throughout their lifespan to ensure they remain current.

Requirements

Bachelor’s Degree in Business Administration or Healthcare Management, or a related field
Two (2) or more years of leadership experience
Five (5) or more years of experience in contract management/negotiation of healthcare contracts (Behavioral Health, Addiction, Integrated Care) in multiple settings (e.g. outpatient, facility, physician/provider, etc.)
Experience with rate setting and analysis
Working knowledge in key healthcare operations (e.g., claims/billing, coding, credentialing)

Nice To Haves

Master’s in Business Administration or Public Administration
Three (3) or more years of experience with rate setting and analysis
AHCCCS Health plan contracting experience
Knowledge of healthcare industry – statutes and regulations in Medicaid, Medicare, and Commercial systems
Knowledge of behavioral health, addiction and physical health services
Knowledge of multiple reimbursement strategies: FFS, Pay for Performance, Full Risk
Knowledge of ACOs and contracting with ACOs
Commercial Health plan contracting experience and building relationships
Accountable Care Organization experience
Multi-state healthcare payer strategy or contracting experience

Responsibilities

Contracting healthcare services provided by Community Bridges, Inc. (CBI) with Medicaid, Medicare and Commercial payers, and government entities (e.g. counties, cities, other municipalities)
Serving as the point of contact for internal inquiries regarding health plan contract needs
Implementing contracting strategies identified by the Executive Leadership Team (ELT)
Working collaboratively with all internal departments to ensure there is awareness and knowledge of contracts and contract requirements
Participating in payer Joint Operations Committee (JOC) meetings
Being involved in contracts with Accountable Care Organizations
Working closely with the VP Payer Relations to provide status updates on contracting opportunities, existing contracts that require amendments, and ensure legal review is completed prior to recommending signature
Establishing the necessary structures for tracking and monitoring contracts through the lifespan to ensure contracts are current