Manager, Contract & Credentialing

Umpqua Health•Roseburg, OR

About The Position

The Contract and Credentialing Manager is responsible for supporting service area agreements with highly visible providers, including integrated delivery systems, hospitals, and physician groups. This role ensures contracts deliver high-quality, cost-effective, and marketable provider networks that meet organizational standards. The position also manages corporate and network contracts to support strategic goals and oversight of all delegated credentialing.

Requirements

Bachelor’s degree in a healthcare-related field or equivalent combination of education and experience.
5–7 years of experience in Medicaid contracting and healthcare network management.
Knowledge of Medicaid, Medicare and Commercial healthcare operations, compliance, and credentialing processes.
Strong organizational, analytical, and problem-solving skills.
Effective communication and interpersonal skills, with the ability to collaborate across teams.
Ability to manage competing priorities and meet deadlines in a fast-paced environment.
Accountability: Takes ownership of responsibilities and outcomes.
Integrity: Maintains confidentiality and adheres to ethical standards.
Innovation: Identifies opportunities for improvement and implementing solutions.
Collaboration: Works effectively with diverse teams and stakeholders.

Responsibilities

Manage high-priority physician group, facility, corporate, and network contracts in alignment with PADU (Preferred, Acceptable, Discouraged, Unacceptable) guidelines.
Develop, negotiate, execute, and maintain provider contracts within contract management systems.
Recruit and negotiate with providers to improve network access, reduce grievances, and support cost control strategies, including Medical Loss Ratio (MLR) optimization.
Maintain effective relationships with key providers and advise Contract Coordinators and Specialists on provider and ancillary contract negotiations.
Evaluate network performance and implement strategies to ensure compliance with network adequacy standards.
Ensure contract language meets organizational and regulatory requirements in collaboration with legal counsel.
Support development of fee schedules and reimbursement models in partnership with Corporate Network Management and legal.
Educate internal stakeholders on provider contracting processes.
Participate in strategic initiatives and organizational committees.
Ensure timely submission of all required contracting related deliverables to the Oregon Health Authority.
Collaborate with internal departments to gather data and documentation for OHA reporting.
Oversee and coordinate Network Performance Subcommittee.
Oversee delegated credentialing entities for compliance.
Provide leadership and supervision to the Contracting and Network team.
Perform other duties as assigned